By David Pennington , published by Melbourne University Publishing , Carlton , Vic. 2010 , 389 pages , hardback , ISBN 9780522857443 ; RRP $69.99 .

Reviewed by Robert Burton

School of Public Health and Preventive Medicine, Monash University, Victoria

David Pennington's first encounter with a clash between Australian culture and public health came within two years of his return to Australia in 1968 as First Assistant (Associate Professor) in the Department of Medicine at St Vincent's Hospital in Melbourne. He had left his undergraduate medical degree at Melbourne University in 1950 to take up a Dominions Clinical Scholarship at Oxford University. Professor Carl de Gruchy, Head of the Department of Medicine at St Vincent's Hospital, recruited David Pennington in 1967 from his London base, consulting in Harley Street and at the London Hospital in Whitechapel, where he had settled after completing his medical education at Oxford University and Hammersmith Hospital.

Wernicke's encephalopathy, a progressive irreversible form of dementia consequent to a lack of thiamine in the diet and long-term alcohol abuse, was commonly seen in the Alcoholism Unit at St Vincent's Hospital. David Pennington had not seen a case of Wernicke's encephalopathy in London, because during World War II the British Government had added thiamine to bread. Together with Beverly Wood, the St Vincent's dietician, he set up assays to measure urinary thiamine and published reports indicating that “supplementation of beer, or indeed of bread, with thiamine could prevent this devastating disease”. The proposal was ridiculed by beer drinkers and damned by the tabloid press and talkback radio alike, however the disease only disappeared when the Australian Government mandated that thiamine be added to bread some years later.

Fifteen years later, in 1984, as Chair of the National AIDS Task force, David Pennington was to face his second and Australia's most serious public health challenge in the 20th Century, again a clash of Australian cultures and public health science.

In the intervening years he had acquired a great deal of experience in individual, group and institutional negotiation, as well as the ability to inspire others and lead change and innovation. He had become Professor of Medicine at St Vincent's Hospital in 1970, and in 1978 he was appointed Chairman of the National Blood Transfusion Committee, which was responsible for the oversight of the state-based Red Cross blood banks, and Dean of the Faculty of Medicine at the University of Melbourne.

By 1983 he was a member of the National Health and Medical Research Council (NHMRC), having served on its Executive and Research Advisory Committee and established its working party on AIDS. In late 1983, the Health Minister in the reformist Hawke/Keating Federal Government, Dr Neal Blewitt, agreed that this NHMRC working party should become the National AIDS Task force.

Australia's success as the first developed country to control HIV/AIDS is well told from the viewpoint of a central and key individual who played a crucial role in that success. David Pennington came to understand the concerns of the gay and wider communities, the difficulties involved in negotiating with Federal and State government politicians and bureaucrats, as well as developing strategies to prevent blood and blood products from becoming contaminated. The HIV virus was first detected in an Australian Blood Bank donation that had been made in 1980. This was three years before it was known that HIV/AIDS was likely to be a sexually transmitted viral disease largely spread by men who have sex with men, the injection of blood and blood products therapeutically and/or through illicit drug use. After the causative retrovirus was isolated in 1984, Australia became the first country to develop a test for HIV in donated blood and ensure that recipients of blood and blood products would not become infected.

David Pennington's third major public health contribution again brought him to where science and logic confronted Australian culture, community myths and prejudices, and government conservatism and timidity. Moss Cass, a medical practitioner and Minister in the Whitlam Government, had advised him in 1983 that “If you want to change a Minister's view on anything, you have to get out and change public opinion. As ministers want to be re-elected, they would change their views if they perceived a shift in public opinion”. This advice was helpful to David Pennington in the fight against HIV/AIDS and was also critical to his understanding of why a logical solution to illicit drug use in Australia still eluded this country. In 1995, as he completed his Vice Chancellorship of the University of Melbourne, Jeff Kennett, the Premier of Victoria, asked him to chair the new Drug Advisory Council, which was to find a solution to illicit drugs. Based on Australian and international experience and advice that prohibition and policing were both ineffective and promoted criminal involvement and substantial harm, the Council recommended that marijuana should be decriminalised and a heroin injecting trial initiated. The initial response from the Howard Federal Government was supportive, with the Ministerial Council on Drug Strategy, chaired by the Health Minister Dr Michael Wooldridge, voting in 1987 6:3 in favour of proceeding with a national heroin trial. However, the Prime Minister John Howard vetoed this and a new federal policy –Tough on Drugs– was released on 19 August 1997.

With precision and detail this rich and well written autobiography describes other professional lives, research on the biology of platelets, reforms to medical education, and a public life in medical research and practice. David Pennington generously shares credit with the many individuals and organisations with whom he worked for the achievements he describes. There are also glimpses of an interesting private life, but above all this is an account of more than half a century spent as an influential, intelligent, caring and public-spirited physician.