Colleagues will be sorry to learn of the death, on 3 February, of Richard Lacey, Professor in Clinical Microbiology. The following tribute has been contributed by his friend and former colleague, Dr John Heritage.
After qualifying as a medical doctor at the University of Cambridge, Richard took up a lectureship and later a reader’s post at the University of Bristol, where he gained his PhD. He had a lifelong passion to warn of the threat of antibiotic resistance, long before this was more widely viewed as a serious threat. At the end of the 1960’s an influential government report advised that antibiotics used in human health should not be used as animal growth promoters. While agreeing with the advice, Richard would criticise this work because, in his view, it allowed doctors over-prescribing antibiotics for humans the opportunity to blame vets and farmers. He argued that all users share the blame.
A particular concern was combination therapy, where two drugs are used where one would be sufficient. Richard argued that the use of two agents increased the total load of antibiotics in use and not only increased the risk of developing resistance but also meant that the chanced of a patient suffering serious side-effects was also increased. Of particular concern was co-trimoxazole, the combination of sulphamethoxazole and trimethoprim. Sulphamethoxazole is a sulphonamide drug that inhibits a metabolic pathway found in bacteria but that is absent in humans. Despite this absence of human target, use of sulphonamide drugs is associated with a rare reaction that is potentially fatal. On its first introduction into clinical medicine, trimethoprim was intended to ‘potentiate’ the action of sulphonamides. It blocks later step in the metabolic pathway than the point at which the sulphonamides act. Richard argued that it would have a role as a single agent, reducing the risks associated with combination therapy. He took on the might of the pharmaceutical industry and won. Now, trimethoprim is used as a single agent and is the first-line treatment for lower urinary tract infections.
Richard was also a pioneer in the field of methicillin-resistant Staphylococcus aureus (MRSA). This work was largely undertaken when Richard was a consultant microbiologist at King’s Lynn. When in the mid-1980s the patent for amoxicillin expired, Richard celebrated with a party. However, this was not a conventional gathering – he organised an antibiotic-tasting session to see who could identify antibiotic syrups from their flavours. His work on trimethoprim and MRSA was central in his being offered the Chair in Clinical Microbiology at Leeds in 1983.
At Leeds, his research interests diversified and he became interested in food-borne pathogens. This happened in part because of the aftermath of the Stanley Royd tragedy in which nineteen patients died from salmonella food poisoning at the Wakefield hospital over the August bank holiday in 1984. Before the incident, the microbiology lab at Wakefield lost its Microbiologist as part of NHS rationalisation plans and so Richard assumed responsibility for the diagnostic lab at Wakefield until a new consultant was appointed. He commuted daily between Leeds and Wakefield and this prompted him to write to the then Secretary of State for transport suggesting that the definition of a motorway should be changed to read that “A motorway is a long stretch of tarmac, bounded on either side by a wall of traffic cones and on which the maximum permissible speed is 10 miles per hour”.
Richard was particularly concerned with the increase in infections caused by Listeria monocytogenes in immunologically vulnerable patients and he linked this rise with the increased use of cook-chill food technology. Another food issue that occupied Richard’s attention was the rise of Salmonella Enteritidis in egg products. This caused incidents that were well-publicised at the time, including one in the House of Lords and another in Cardiff prison. The pathogen responsible was a new strain that emerged during the 1980s and was made infamous for the claim made by Edwina Currie that “…most of the egg production in this country, sadly, is now affected with salmonella". This somewhat overstated the threat and it led to Ms Currie’s sacking. During the salmonella scare, it was not unusual for Richard’s PA to receive a phone call from Robin Cook, who was Shadow Health Secretary at the time. However, Richard’s most significant contribution to the public health threat posed by food was when he highlighted the threat posed to humans of bovine spongiform encephalopathy: BSE or mad cow disease. This made Richard an international celebrity and it was once said that the only way to meet him was to promise to take a film crew with you. Richard’s opinions were so controversial that his appearance before the Government BSE enquiry were timetabled for budget day, so that he would have serious competition for news headlines. In 1989, Richard was presented with the Evian Health Award by HRH Princess of Wales. Richard made numerous court appearances as an expert witness in food-related cases.
Richard took early retirement from the University, with the hope of combining his interest in food with that of his passion for antibiotics with the hope of opening the UKs first antibiotic-free pub. Richard had a wicked sense of humour. One of the more vicious cuts in University funding occurred when he had assumed the role of head of department. Ahead of one staff meeting, he circulated a paper on money-saving measures. The first paragraph set out the case for cuts in a typically concise fashion. However, suspicions were raised in the second paragraph where there was a rota for staff to fund-raise by rattling collection tins on the Headrow. The third paragraph gave the game away. Richard proposed realigning research group studying cyanobacteria, aka blue-green algae, with the Skin Research Group, to investigate blue-green spots.
As a teacher, Richard was loved, not only as an expert in his field but as a great entertainer. He never seemed to prepare lecture material for students, but always held them spell-bound. For undergraduate lectures, he eschewed the use of visual aids, but his seminars were liberally peppered with random slides – charging rhinoceroses, umbrellas and rainbow-coloured mushrooms all had their place. He famously paraphrased Jeremy Bentham’s caveat on verbosity as “The more antibiotics there are, the more antibiotics there are about which doubt may be entertained”. Beyond academia, Richard had a passion for gardening and was an accomplished painter. He also amassed a very impressive collection of antique tea caddies. He could be very frustrating to work with at times but association with Richard was never dull and often very exciting. The world of medical microbiology has lost a huge talent.Richard is survived by daughters Miranda and Gemma and grandchildren Amber, Josh and Theo.