Professor Kenneth Michael Welch

Doctor of Medicine

17 July 2006 - Orator: Professor Neil Scolding

Madam Pro Vice-Chancellor:

1970 was a bad year for England. Germany took revenge on Alf Ramsay’s World Cup holders, beating England 3-2 after extra time in Leon. Doctors wrote twelve million prescriptions for sedatives, mainly Mogadon and Valium.  On BBC television’s Top of the Pops – now to be lost forever, of course – Rolf Harris could be seen and, sadly, heard, singing his number one hit “Two Little Boys”. And finally in 1970, a young hospital doctor working in Sheffield took what must surely have been a momentous decision, and left these shores to take up a neurology research position in Houston, Texas. He later spent a year in Sydney, has worked in various centres in America, and is now in Chicago – but he has never worked in the UK since that fateful year.

Now I should say immediately that history might have been different. Gordon Banks might not have got gastroenteritis, and so played, instead of the hapless Peter Bonetti. And that young doctor who published in 1970 an article in an extremely reputable – indeed the most reputable – respiratory medicine journal on ‘Mushroom worker's lung’; he might have remained attracted to lung diseases and remained in Britain. But a combination of wanderlust, and an interest in neurology, led to his departure to the Lone Star State.

You might expect me to say at this stage that ‘England’s loss was America’s gain’. I will (and indeed I have), and it is true, but that brief phrase comes nowhere near doing justice to what has been the truly remarkable career of Professor Michael Welch, neurological clinician and scientist, whom I have the pleasure and privilege of introducing to you today.

Describing Professor Welch as a neurologist in Chicago also qualifies as something of a dangerously misleading understatement. To the general populus (though not of course this distinguished audience), a ‘neurologist’ is an unfamiliar curiosity, generally considered not as clever as a brain surgeon and by no means as useful as a psychiatrist, while the closest most of us have been to ‘Chicago’ is the dress circle of the Bristol Hippodrome last June.

So perhaps some background would be in order.

In 1912, an extraordinary new medical school was formed in Chicago, the Chicago Hospital College of Medicine. Contrary to prevailing political wisdom and social mores, it rejected the use of quotas to limit minority enrolment: students were welcomed without regard to race or gender. Growing in success, it remained true to these values, and two decades later became a haven for Jewish researchers and faculty, recruited in great numbers as they fled Nazi Europe. Its reputation for taking radical positions continued in the early 1960s when, changing its name to “The University of Health Sciences”, it championed the idea that medical students and students of other healthcare professions should be brought together, and that by learning together they would come to respect each others' contributions – a voice in the wilderness then, but something which thirty years later became mainstream healthcare philosophy. Showing an intellectual restlessness perhaps not unlike our prospective graduand today, moving physically several times within Chicago, changing its name to the Finch University of Health Sciences (and Chicago Medical School), it continued to expand and develop in both size and success. It is now in north Chicago on a campus of 50 acres, with a faculty of almost 750, and over 1500 postgraduates.

And in 2002, 32 years after leaving England, our young ex-patriot physician scientist took up a position there – not as a teaching neurologist, nor even head of neurology or research, but in the distinguished position of President and Chief Executive Officer of the University.

What path had led him to this role of extraordinary leadership and responsibility, our young graduate of the medical school here at Bristol, who played a rather different though still proud role at this very ceremony in another year of great resonance to his home nation – 1966 – and who then patrolled the wards as House Physician just along the road at the Bristol Royal Infirmary, and as House Surgeon a few miles away at Southmead Hospital. Let us look at the career – a model for academic medicine – that led to such success.

From Bristol, Dr Welch went to Sheffield, firstly to an SHO post, and then to the position of Registrar in General Medicine and Neurology. Here he first developed an interest in neurology – and not just an interest in the clinical phenomenology, but in the clinical science of neurology as well as the medicine. In addition to his passing contribution to respiratory medicine in 1970, he also published that year his first neurology contribution to the literature, namely a letter on blood flow in the brain, and stroke, in the Lancet.

Neurologists – and I speak as a humble member of that order – are widely seen as the sad anoraks of medicine, spending our happiest waking hours collecting, and painstakingly updating, long, long lists of vanishingly rare conditions, preferably all carrying 19th century French or German eponyms and (of course) invariably untreatable. It might be said that the term ‘Asperger’s’ was invented ‘by neurologists, for neurologists’.

Now I hint this description is widely accepted, but I fear it may be an English, or at best a British peculiarity. Dr Welch does not fit into this geekish mould – and indeed perhaps this helps to explain why a conventional and conformist higher training and career at Queen Square, the iconic centre of British neurology, proved no attraction to him.

So, after a spectacularly successful first clinical research post at Baylor in Houston, and then a year at the National Health and Medical Research Institute in Sydney, he was appointed at the disgracefully young age – an extraordinary mere seven years after qualification from Bristol – Director of the Division of Neurometabolism back in Texas. He stayed in Houston, becoming Chief of Service in 1976, and then moved north to Detroit, gaining the William T Gossett Chair in Neurology in 1981. His rise continued, and in 1989 he was appointed Vice President of Academic affairs at the Henry Ford Hospital in Detroit. He then moved again to become President of the Research Institute at the University of Kansas Medical Centre in 1999, and then three years later took up his current presidential position in Chicago.

Perhaps the most important aspect of his success has been that, eschewing neurological rarities and seeing no great attraction in the rather sterile art of clinical phenomenonology, Dr Welch has throughout this remarkable career concentrated his talents on easily the two the most important diseases of the nervous system – headache, and stroke. It seems hard to understand, and harder still to defend – but these disorders, vast causes of disability, distress and morbidity, with enormous heath economic implications, were, throughout the 80’s and most of the 90’s, and most certainly before then, considered completely and utterly beyond the pale for the Great British neurologist. “Far too common and ordinary” seems to be the problem.

It is though actually through Professor Welch’s achievements over the last few decades that this state of affairs has now changed so dramatically. Even in the UK, stroke neurology has now become part of the mainstream specialty, and the National Hospital at Queen Square, in London, appointed its first ever Professor of Headache Neurology some seven or eight years ago.

If Professor Welch’s career, acting as a bright transatlantic beacon, had achieved only this fundamental alteration – a maturation or even enlightenment – in the practice of British, and indeed world neurology, this would have been remarkable enough, but this is only an unintentional side effect, as it were, of his activities. What he has done, with constant, consistent and continuing success, has been fundamentally to alter the clinical science of migraine, and that of stroke, to the potential benefit of countless millions of sufferers now, and in the future. Through building multi-faceted programmes of clinical research, exploring and dissecting the underlying biological basis, the clinical features and recognition, developing and studying experimental models, improving diagnosis and imaging techniques and, not the least important, pioneering new treatments for stroke and for headache syndromes, first and foremost migraine, his work has advanced almost immeasurably both the medical science of, and clinical practice in, these disorders. His work throughout has maintained a constant relevance. Important early work 15 years ago drew our attention to the roles of the contraceptive pill, and of smoking, in these diseases. Even before this, he was one of the first to recognise and describe the causal relationship between "crack" cocaine and stroke, nearly 20 years ago.

I mentioned earlier the first ever UK Professor of Headache Neurology at Queen Square, and to avoid giving you the impression of my own personal bias I sought his views on our subject today. I will quote Professor Goadsby :

“Pioneer would be the word...

He used MRI in headache research when others did not know what the letters stood for…

Explored brain excitation as a metaphor for understanding migraine when the field was obsessing mindlessly over blood vessels…

Brought science to Cephalalgia as Editor-in-Chief in a way that the field had not contemplated.”

(Peter also mentioned a starring role in a "Headache Comedians Night" at the Amsterdam International Headache Congress in the late 90s which perhaps we needn’t dwell upon …. although he did say you “brought the house down in laughter and admiration”.)

And summing up, Professor Goadsby went on to say, “entertainer, teacher, clinician, mentor, researcher, academic, father and friend .... pick the adjective, they all apply.”

Professor Welch’s work has been recognised, and is witnessed, by an almost painfully long list of national and international awards, prizes and positions, but it would be true to say that he has been so honoured only in perfect proportion to the contribution he has made and, moreover, unfashionable phrase though it is, the service he has rendered. I am delighted and honoured as an academic neurologist at Dr Welch’s alma mater to help express the University of Bristol’s proud recognition of his splendid achievements and, Madam Pro Vice-Chancellor, to present to you Kenneth Michael Welch as eminently worthy of the degree of Doctor of Medicine, honoris causa.