Breakthrough as scientists grow sheep embryos containing human cells

Advance brings us closer to growing transplant organs inside animals or being able to genetically tailor compatible organs, say researchers

In 2016, almost 460 people in the UK died waiting for transplant organs to become available.


In 2016, almost 460 people in the UK died waiting for transplant organs to become available. Photograph: Sean Smith for the Guardian

Growing human organs inside other animals has taken another step away from science-fiction, with researchers announcing they have grown sheep embryos containing human cells.

Scientists say growing human organs inside animals could not only increase supply, but also offer the possibility of genetically tailoring the organs to be compatible with the immune system of the patient receiving them, by using the patient’s own cells in the procedure, removing the possibility of rejection.

According to NHS Blood and Transplant, almost 460 people died in 2016 waiting for organs, while those who do receive transplants sometimes see organs rejected.

“Even today the best matched organs, except if they come from identical twins, don’t last very long because with time the immune system continuously is attacking them,” said Dr Pablo Ross from the University of California, Davis, who is part of the team working towards growing human organs in other species.

Ross added that if it does become possible to grow human organs inside other species, it might be that organ transplants become a possibility beyond critical conditions.

Bruce Whitelaw, professor of animal biotechnology at the Roslin Institute, where Dolly the sheep was created, said that while there was a long way to go before human organs could be grown in other animals, the latest research is “an important step forward through starting to explore whether sheep offer an option for the exciting ‘chimeric’ project.”

The approach is different to xenotransplantation, in which an organ that belongs to another species is transplanted into humans. While that is another possibility for tackling the dearth of organs, rejection would still be a problem.

Attempts by scientists to grow organs from one species inside another is an ongoing mission: among previous efforts, scientists have grown a rat pancreas inside a mouse.

But Ross and colleagues have recently reported a major breakthrough for our own species, revealing they were able to introduce human stem cells into early pig embryos, producing embryos for which about one in every 100,000 cells were human. These chimeras – a term adopted from Greek mythology – were only allowed to develop for 28 days.

Now, at this week’s meeting of the American Association for the Advancement of Science in Austin, Texas, the team have announced that they have managed a similar feat with sheep embryos, achieving an even higher ratio of human to animal cells. “About one in 10,000 cells in these sheep embryos are human,” said Ross.

The team say they have already been able to use genome editing techniques to produce pig and sheep embryos that are unable to develop a pancreas, although they are still working on the approach. The hope is that the human cells introduced to such embryos would grow to replace the missing organ.

The team are currently allowed to let the chimeric embryos develop for 28 days, 21 of which are in the sheep. While that might be sufficient to see the development of the missing organ when human cells are eventually combined with the genetically modified embryo, Dr Hiro Nakauchi of Stanford University, who is part of the team, said a longer experiment, perhaps up to 70 days, would be more convincing, although that would require additional permission from institutional review boards.

But, Ross said, for the approach to work it is thought that about 1% of the embryo’s cells would have to be human, meaning further work is needed to increase the proportion of human cells in the chimera.

chimera graphic

Ross added there are several advantages to using sheep embryos, including that they can easily be produced by IVF, and that fewer embryos need to be transplanted into an adult, meaning fewer embryos are needed for an experiment.

“For a pig we typically transfer 50 embryos to one recipient,” said Ross. “With the sheep we transfer four embryos to one recipient.”

Sheep also have certain organs – such as the heart and lungs – that are similar to ours, and their embryos have been shown to form chimeras with goat embryos to produce “geeps”. Like pigs, sheep produce organs of about the right size for the human body.

Research with pigs is continuing, said Ross, noting that they have other benefits including speed of growth and the ability to produce more young at one time than sheep, meaning fewer animals are needed to produce more data.

But ethical concerns abound, not least whether chimeras could end up with a human-like mind.

“I have the same concerns,” said Ross, adding that the team are looking at where the human cells end up in the chimera. “Lets say that if our results indicate that the human cells all go to the brain of the animal, then we may never carry this forward,” he said.

Nakauchi is optimistic that humans will eventually be able to receive organs grown in animals. “It could take five years or it could take 10 years but I think eventually we will be able to do this,” he said.

Nakauchi also played down concerns: “The contribution of human cells so far is very small. It’s nothing like a pig with a human face or human brain,” he said. “We have published several papers showing we can target the region, so we can avoid human cells differentiating in to the human brain or human gonads.”

Other potential issues includethat viruses within the DNA of the host could infect human cells, while the human organ might contain blood vessels composed of cells from the “host” animal. “The organs could not be used for transplants into humans without triggering the immune system to reject them – and this would probably be a very fast rejection,” said Robin Lovell-Badge, head of the division of stem cell biology and developmental genetics at the Francis Crick Institute in London.

However, recent developments in gene editing have allowed scientists to develop piglets without such viruses, potentially smoothing the way, while Ross notes that human cells might replace any remaining host cells after transplantation.

Currently, the US National Institutes of Health has a moratorium on funding such research, but it is looking to lift this and replace it with a review process. In the UK scientists must apply to the Home Office for a license to carry out such research.

Breakthrough as scientists grow sheep embryos containing human cells

Advance brings us closer to growing transplant organs inside animals or being able to genetically tailor compatible organs, say researchers

In 2016, almost 460 people in the UK died waiting for transplant organs to become available.


In 2016, almost 460 people in the UK died waiting for transplant organs to become available. Photograph: Sean Smith for the Guardian

Growing human organs inside other animals has taken another step away from science-fiction, with researchers announcing they have grown sheep embryos containing human cells.

Scientists say growing human organs inside animals could not only increase supply, but also offer the possibility of genetically tailoring the organs to be compatible with the immune system of the patient receiving them, by using the patient’s own cells in the procedure, removing the possibility of rejection.

According to NHS Blood and Transplant, almost 460 people died in 2016 waiting for organs, while those who do receive transplants sometimes see organs rejected.

“Even today the best matched organs, except if they come from identical twins, don’t last very long because with time the immune system continuously is attacking them,” said Dr Pablo Ross from the University of California, Davis, who is part of the team working towards growing human organs in other species.

Ross added that if it does become possible to grow human organs inside other species, it might be that organ transplants become a possibility beyond critical conditions.

Bruce Whitelaw, professor of animal biotechnology at the Roslin Institute, where Dolly the sheep was created, said that while there was a long way to go before human organs could be grown in other animals, the latest research is “an important step forward through starting to explore whether sheep offer an option for the exciting ‘chimeric’ project.”

The approach is different to xenotransplantation, in which an organ that belongs to another species is transplanted into humans. While that is another possibility for tackling the dearth of organs, rejection would still be a problem.

Attempts by scientists to grow organs from one species inside another is an ongoing mission: among previous efforts, scientists have grown a rat pancreas inside a mouse.

But Ross and colleagues have recently reported a major breakthrough for our own species, revealing they were able to introduce human stem cells into early pig embryos, producing embryos for which about one in every 100,000 cells were human. These chimeras – a term adopted from Greek mythology – were only allowed to develop for 28 days.

Now, at this week’s meeting of the American Association for the Advancement of Science in Austin, Texas, the team have announced that they have managed a similar feat with sheep embryos, achieving an even higher ratio of human to animal cells. “About one in 10,000 cells in these sheep embryos are human,” said Ross.

The team say they have already been able to use genome editing techniques to produce pig and sheep embryos that are unable to develop a pancreas, although they are still working on the approach. The hope is that the human cells introduced to such embryos would grow to replace the missing organ.

The team are currently allowed to let the chimeric embryos develop for 28 days, 21 of which are in the sheep. While that might be sufficient to see the development of the missing organ when human cells are eventually combined with the genetically modified embryo, Dr Hiro Nakauchi of Stanford University, who is part of the team, said a longer experiment, perhaps up to 70 days, would be more convincing, although that would require additional permission from institutional review boards.

But, Ross said, for the approach to work it is thought that about 1% of the embryo’s cells would have to be human, meaning further work is needed to increase the proportion of human cells in the chimera.

chimera graphic

Ross added there are several advantages to using sheep embryos, including that they can easily be produced by IVF, and that fewer embryos need to be transplanted into an adult, meaning fewer embryos are needed for an experiment.

“For a pig we typically transfer 50 embryos to one recipient,” said Ross. “With the sheep we transfer four embryos to one recipient.”

Sheep also have certain organs – such as the heart and lungs – that are similar to ours, and their embryos have been shown to form chimeras with goat embryos to produce “geeps”. Like pigs, sheep produce organs of about the right size for the human body.

Research with pigs is continuing, said Ross, noting that they have other benefits including speed of growth and the ability to produce more young at one time than sheep, meaning fewer animals are needed to produce more data.

But ethical concerns abound, not least whether chimeras could end up with a human-like mind.

“I have the same concerns,” said Ross, adding that the team are looking at where the human cells end up in the chimera. “Lets say that if our results indicate that the human cells all go to the brain of the animal, then we may never carry this forward,” he said.

Nakauchi is optimistic that humans will eventually be able to receive organs grown in animals. “It could take five years or it could take 10 years but I think eventually we will be able to do this,” he said.

Nakauchi also played down concerns: “The contribution of human cells so far is very small. It’s nothing like a pig with a human face or human brain,” he said. “We have published several papers showing we can target the region, so we can avoid human cells differentiating in to the human brain or human gonads.”

Other potential issues includethat viruses within the DNA of the host could infect human cells, while the human organ might contain blood vessels composed of cells from the “host” animal. “The organs could not be used for transplants into humans without triggering the immune system to reject them – and this would probably be a very fast rejection,” said Robin Lovell-Badge, head of the division of stem cell biology and developmental genetics at the Francis Crick Institute in London.

However, recent developments in gene editing have allowed scientists to develop piglets without such viruses, potentially smoothing the way, while Ross notes that human cells might replace any remaining host cells after transplantation.

Currently, the US National Institutes of Health has a moratorium on funding such research, but it is looking to lift this and replace it with a review process. In the UK scientists must apply to the Home Office for a license to carry out such research.

Every time I visit my family, they body-shame me

I have been through something similar, says Annalisa Barbieri. Try joking it off – or face the problem head on

illustration of bathroom scales with fingers pointing at the feet on them


Illustration: Lo Cole for the Guardian

I am being constantly body-shamed by my family, and it hurts.

I moved to the UK years ago and built up a good career. I am finishing my master’s degree part-time while working full-time; I have also recently started my first managerial role. Juggling my studies and a full-time job, means I go back to my country only once a year.

However, every time is the same: the first thing my parents say is that I have got fatter, since I went from a size 12 to a size 18. They ration my food. They are also keen to let me know that I have to stop eating badly before I go back to the UK.

This has been going on for years, and I am fed up. When I started working in the UK, I was paid very little and struggled to get the money for a flight;. In the past couple of years, I have started to feel very anxious before going back, and now I have mixed feelings about seeing them again.

You don’t say, but I wondered if your family were Italian. I had this once, visiting wider family – not my mum and dad – after a gap of some years. In the intervening time, I had gone from a childlike figure (size 8) to a womanly one (size 14) and the response was brutal. No mention of any of my achievements, of asking how I was or if I was happy. Nothing to do with me at all. All to do with my weight. It took me a while to work out what was going on.

A size 18 is hardly obese, so it is not as if they can use your health as an excuse for their “concern”. In any case, a far more constructive idea would be to make you feel safe and supported so that you might open up about why you have gained weight – if it bothers you.

I contacted Catherine Crowther, a psychoanalytical psychotherapist (bpc.org.uk). She said: “I wonder if the food/weight issue has become a focus, a cipher for something else that has gone wrong between you and your parents?”

Maybe your parents felt left behind by your moving and that commenting on your weight was a way of expressing that? “Your parents may feel as if they have lost track of you,” suggested Crowther, “and one thing they feel they can do is comment on your weight.” Of course, we want to stress, this does not make it OK.

I am not surprised you feel anxious; your parents are reducing you to little more than your weight. I understand how despairing that can make you feel. They should be focusing on how wonderful it is to see you.

“There must be a certain rage that when you go back they are not seeing you,” Crowther said. “They don’t see your achievements – and you have achieved a lot – only your weight gain.”

Crowther also wondered if there was something in you that was – perhaps – rebelling against your parents, in defiance?

We wondered – not to say that it is easy – why you couldn’t try to make a joke of it and say, “Yes, I love my food”? You mentioned, in your longer letter, a relationship that ended and how food gave you comfort. Of course, eating is a classic way to self-soothe and avoid emotions. But the relief is usually short-lived and the feelings perpetuate. You may want to look at this a bit more.

Practically, you can’t never see your parents again because of this (unless there is more to it than their comments). One way round it may be to Skype, so they can see you more and you can get this issue out of the way before you meet them. Or you could face it head on and say: “I find it really upsetting when you say this – is that all I am to you?” Would it upset you if anyone said it, or is it upsetting because it is your parents? In other words, is it what is being said or who is saying it?

With my family in Italy, I realised I had looked like a teenager for a very long time, so every time they saw me they could convince themselves that time had stood still – I looked the same. That made them feel safe. But when they saw that I’d grown up, they had to face reality: time had ticked on. My weight gain reflected back to them the fact that they were getting old; they dealt with it by blaming me.

Send your problem to annalisa.barbieri@mac.com

Annalisa regrets she cannot enter into personal correspondence.

Follow Annalisa on Twitter: @AnnalisaB

Every time I visit my family, they body-shame me

I have been through something similar, says Annalisa Barbieri. Try joking it off – or face the problem head on

illustration of bathroom scales with fingers pointing at the feet on them


Illustration: Lo Cole for the Guardian

I am being constantly body-shamed by my family, and it hurts.

I moved to the UK years ago and built up a good career. I am finishing my master’s degree part-time while working full-time; I have also recently started my first managerial role. Juggling my studies and a full-time job, means I go back to my country only once a year.

However, every time is the same: the first thing my parents say is that I have got fatter, since I went from a size 12 to a size 18. They ration my food. They are also keen to let me know that I have to stop eating badly before I go back to the UK.

This has been going on for years, and I am fed up. When I started working in the UK, I was paid very little and struggled to get the money for a flight;. In the past couple of years, I have started to feel very anxious before going back, and now I have mixed feelings about seeing them again.

You don’t say, but I wondered if your family were Italian. I had this once, visiting wider family – not my mum and dad – after a gap of some years. In the intervening time, I had gone from a childlike figure (size 8) to a womanly one (size 14) and the response was brutal. No mention of any of my achievements, of asking how I was or if I was happy. Nothing to do with me at all. All to do with my weight. It took me a while to work out what was going on.

A size 18 is hardly obese, so it is not as if they can use your health as an excuse for their “concern”. In any case, a far more constructive idea would be to make you feel safe and supported so that you might open up about why you have gained weight – if it bothers you.

I contacted Catherine Crowther, a psychoanalytical psychotherapist (bpc.org.uk). She said: “I wonder if the food/weight issue has become a focus, a cipher for something else that has gone wrong between you and your parents?”

Maybe your parents felt left behind by your moving and that commenting on your weight was a way of expressing that? “Your parents may feel as if they have lost track of you,” suggested Crowther, “and one thing they feel they can do is comment on your weight.” Of course, we want to stress, this does not make it OK.

I am not surprised you feel anxious; your parents are reducing you to little more than your weight. I understand how despairing that can make you feel. They should be focusing on how wonderful it is to see you.

“There must be a certain rage that when you go back they are not seeing you,” Crowther said. “They don’t see your achievements – and you have achieved a lot – only your weight gain.”

Crowther also wondered if there was something in you that was – perhaps – rebelling against your parents, in defiance?

We wondered – not to say that it is easy – why you couldn’t try to make a joke of it and say, “Yes, I love my food”? You mentioned, in your longer letter, a relationship that ended and how food gave you comfort. Of course, eating is a classic way to self-soothe and avoid emotions. But the relief is usually short-lived and the feelings perpetuate. You may want to look at this a bit more.

Practically, you can’t never see your parents again because of this (unless there is more to it than their comments). One way round it may be to Skype, so they can see you more and you can get this issue out of the way before you meet them. Or you could face it head on and say: “I find it really upsetting when you say this – is that all I am to you?” Would it upset you if anyone said it, or is it upsetting because it is your parents? In other words, is it what is being said or who is saying it?

With my family in Italy, I realised I had looked like a teenager for a very long time, so every time they saw me they could convince themselves that time had stood still – I looked the same. That made them feel safe. But when they saw that I’d grown up, they had to face reality: time had ticked on. My weight gain reflected back to them the fact that they were getting old; they dealt with it by blaming me.

Send your problem to annalisa.barbieri@mac.com

Annalisa regrets she cannot enter into personal correspondence.

Follow Annalisa on Twitter: @AnnalisaB

Every time I visit my family, they body-shame me

I have been through something similar, says Annalisa Barbieri. Try joking it off – or face the problem head on

illustration of bathroom scales with fingers pointing at the feet on them


Illustration: Lo Cole for the Guardian

I am being constantly body-shamed by my family, and it hurts.

I moved to the UK years ago and built up a good career. I am finishing my master’s degree part-time while working full-time; I have also recently started my first managerial role. Juggling my studies and a full-time job, means I go back to my country only once a year.

However, every time is the same: the first thing my parents say is that I have got fatter, since I went from a size 12 to a size 18. They ration my food. They are also keen to let me know that I have to stop eating badly before I go back to the UK.

This has been going on for years, and I am fed up. When I started working in the UK, I was paid very little and struggled to get the money for a flight;. In the past couple of years, I have started to feel very anxious before going back, and now I have mixed feelings about seeing them again.

You don’t say, but I wondered if your family were Italian. I had this once, visiting wider family – not my mum and dad – after a gap of some years. In the intervening time, I had gone from a childlike figure (size 8) to a womanly one (size 14) and the response was brutal. No mention of any of my achievements, of asking how I was or if I was happy. Nothing to do with me at all. All to do with my weight. It took me a while to work out what was going on.

A size 18 is hardly obese, so it is not as if they can use your health as an excuse for their “concern”. In any case, a far more constructive idea would be to make you feel safe and supported so that you might open up about why you have gained weight – if it bothers you.

I contacted Catherine Crowther, a psychoanalytical psychotherapist (bpc.org.uk). She said: “I wonder if the food/weight issue has become a focus, a cipher for something else that has gone wrong between you and your parents?”

Maybe your parents felt left behind by your moving and that commenting on your weight was a way of expressing that? “Your parents may feel as if they have lost track of you,” suggested Crowther, “and one thing they feel they can do is comment on your weight.” Of course, we want to stress, this does not make it OK.

I am not surprised you feel anxious; your parents are reducing you to little more than your weight. I understand how despairing that can make you feel. They should be focusing on how wonderful it is to see you.

“There must be a certain rage that when you go back they are not seeing you,” Crowther said. “They don’t see your achievements – and you have achieved a lot – only your weight gain.”

Crowther also wondered if there was something in you that was – perhaps – rebelling against your parents, in defiance?

We wondered – not to say that it is easy – why you couldn’t try to make a joke of it and say, “Yes, I love my food”? You mentioned, in your longer letter, a relationship that ended and how food gave you comfort. Of course, eating is a classic way to self-soothe and avoid emotions. But the relief is usually short-lived and the feelings perpetuate. You may want to look at this a bit more.

Practically, you can’t never see your parents again because of this (unless there is more to it than their comments). One way round it may be to Skype, so they can see you more and you can get this issue out of the way before you meet them. Or you could face it head on and say: “I find it really upsetting when you say this – is that all I am to you?” Would it upset you if anyone said it, or is it upsetting because it is your parents? In other words, is it what is being said or who is saying it?

With my family in Italy, I realised I had looked like a teenager for a very long time, so every time they saw me they could convince themselves that time had stood still – I looked the same. That made them feel safe. But when they saw that I’d grown up, they had to face reality: time had ticked on. My weight gain reflected back to them the fact that they were getting old; they dealt with it by blaming me.

Send your problem to annalisa.barbieri@mac.com

Annalisa regrets she cannot enter into personal correspondence.

Follow Annalisa on Twitter: @AnnalisaB

Alan Maynard obituary

Health economist who had a major impact on policy and practice

Alan Maynard was a great communicator and intellectual agent provocateur


Alan Maynard was a great communicator and intellectual agent provocateur

Alan Maynard, emeritus professor of health economics at the University of York, who has died aged 73, was crucial in the development of his discipline into an international profession. He also had a real impact on policy, not just in the UK.

He was, for example, an originator of the idea that better value for money and better outcomes might be achieved if family doctors were given budgets with which to buy their patients’ care. He was an early and public advocate of the principle that, before the NHS paid for them, drug companies should have to show that their new products were not just clinically effective but cost-effective. That idea resulted in the creation in 1999 of Nice, the National Institute for Health and Care Excellence, a model that other countries have adopted and adapted.

Few would have predicted such an impact for the slightly scrawny kid growing up in postwar Bebington in Cheshire, the son of Edward Maynard, a shoe buyer, and his wife, Hilda (nee McCausland). “He hated school and didn’t really learn to read properly until he was nine,” according to Elizabeth Shanahan, whom Maynard met as a teenager and married in 1968, in one of the few conventional acts of his life. “The world was in revolt,” Liz recalled, “but we got married with lots of bridesmaids and Pyrex casseroles.”

He had scraped into the local grammar school, only to be told bluntly that he would never get to university. But two A-levels took him to Newcastle, initially to do accountancy – “something he also hated” – before a switch to economics took him to the subject that, Liz said, quite simply made him. A second degree at York led to an assistant lectureship at Exeter University alongside Tony Culyer, an equally influential economist.

Back in the 1960s, few economists believed health was a subject fit for their high-minded attention. But Culyer and Maynard, along with Alan Williams, who recruited the pair to York – Maynard became lecturer in economics there in 1971 – are now seen as the founding fathers of health economics in the UK.

Once at York, Maynard created an MSc in the subject and then, in 1983 (the year in which he was appointed professor), established the Centre for Health Economics, which in turn produced “the York diaspora”. More than 750 of its graduates now work in governments, universities, pharmaceutical companies, health services and think tanks around the world. He was an inspirational teacher not just of economists but of medical students, who would find themselves facing questions such as “Is killing people wrong?” Lectures and supervisions were laced with irony, humour and challenge, but also kindness and compassion.

Maynard authored or co-authored more than 500 academic papers, was founding editor in 1992 of what is now the leading journal Health Economics, and in 2015 was awarded the Graham prize – the closest health services research gets to a Nobel prize. However, his role as a great communicator and intellectual agent provocateur was at least as important as his academic work. He wrote countless, often irreverent, media columns, and engaged endlessly with journalists, because, to paraphrase his guide on how to get research translated into action, “you have to find your allies anywhere and everywhere”.

He spent a good chunk of his life hurling squibs of wit and doses of wisdom at the great, the good, and the misguided in the world of healthcare. Politicians were criticised for faith-based rather than evidence-based policy, and for failing to evaluate what they did. The august medical royal colleges were accused of taking taxpayer funded grants but failing to protect patients. The stricture that the NHS has been subject to repeated “re-disorganisation” is almost certainly Maynard’s. And he knew all about that, because, unlike many academics, he was “covered in coal dust” – he was the chair or a director of his local NHS organisations for more than 20 years.

His willingness to throw a match into any passing box of fireworks won him adoring fans. But it also made him enemies. To some he seemed just flippant, a trouble-maker. And he could overdo it. But behind the barbs was almost always a kernel of truth that even those who were wounded could come in time to recognise. Many who mattered most always recognised his value – the Department of Health, the Commons health select committee, the World Bank and the World Health Organisation were just some of those who called in his wisdom as well as his wit.

For behind the irreverence, the alliance building and the provocation was a serious intent – a profound moral belief that it was everyone’s duty to get the best value out of healthcare expenditure. The incentives and vested interests that stood in the way of that had to be challenged. Better incentives had to be found. The success of healthcare had to be measured by its outcomes, not its inputs – and that included the then revolutionary idea that patients themselves, not the just the clinicians, should be asked systematically whether their operation had in fact proved a success. For all that and more, modern healthcare owes him much. Maynard’s manoeuvres were masterful. And indeed a success.

He is survived by Liz and their children, Justin, John, Jane and Samantha, and his older sister, Jean.

Alan Keith Maynard, health economist, born 15 December 1944; died 2 February 2018

Alan Maynard obituary

Health economist who had a major impact on policy and practice

Alan Maynard was a great communicator and intellectual agent provocateur


Alan Maynard was a great communicator and intellectual agent provocateur

Alan Maynard, emeritus professor of health economics at the University of York, who has died aged 73, was crucial in the development of his discipline into an international profession. He also had a real impact on policy, not just in the UK.

He was, for example, an originator of the idea that better value for money and better outcomes might be achieved if family doctors were given budgets with which to buy their patients’ care. He was an early and public advocate of the principle that, before the NHS paid for them, drug companies should have to show that their new products were not just clinically effective but cost-effective. That idea resulted in the creation in 1999 of Nice, the National Institute for Health and Care Excellence, a model that other countries have adopted and adapted.

Few would have predicted such an impact for the slightly scrawny kid growing up in postwar Bebington in Cheshire, the son of Edward Maynard, a shoe buyer, and his wife, Hilda (nee McCausland). “He hated school and didn’t really learn to read properly until he was nine,” according to Elizabeth Shanahan, whom Maynard met as a teenager and married in 1968, in one of the few conventional acts of his life. “The world was in revolt,” Liz recalled, “but we got married with lots of bridesmaids and Pyrex casseroles.”

He had scraped into the local grammar school, only to be told bluntly that he would never get to university. But two A-levels took him to Newcastle, initially to do accountancy – “something he also hated” – before a switch to economics took him to the subject that, Liz said, quite simply made him. A second degree at York led to an assistant lectureship at Exeter University alongside Tony Culyer, an equally influential economist.

Back in the 1960s, few economists believed health was a subject fit for their high-minded attention. But Culyer and Maynard, along with Alan Williams, who recruited the pair to York – Maynard became lecturer in economics there in 1971 – are now seen as the founding fathers of health economics in the UK.

Once at York, Maynard created an MSc in the subject and then, in 1983 (the year in which he was appointed professor), established the Centre for Health Economics, which in turn produced “the York diaspora”. More than 750 of its graduates now work in governments, universities, pharmaceutical companies, health services and think tanks around the world. He was an inspirational teacher not just of economists but of medical students, who would find themselves facing questions such as “Is killing people wrong?” Lectures and supervisions were laced with irony, humour and challenge, but also kindness and compassion.

Maynard authored or co-authored more than 500 academic papers, was founding editor in 1992 of what is now the leading journal Health Economics, and in 2015 was awarded the Graham prize – the closest health services research gets to a Nobel prize. However, his role as a great communicator and intellectual agent provocateur was at least as important as his academic work. He wrote countless, often irreverent, media columns, and engaged endlessly with journalists, because, to paraphrase his guide on how to get research translated into action, “you have to find your allies anywhere and everywhere”.

He spent a good chunk of his life hurling squibs of wit and doses of wisdom at the great, the good, and the misguided in the world of healthcare. Politicians were criticised for faith-based rather than evidence-based policy, and for failing to evaluate what they did. The august medical royal colleges were accused of taking taxpayer funded grants but failing to protect patients. The stricture that the NHS has been subject to repeated “re-disorganisation” is almost certainly Maynard’s. And he knew all about that, because, unlike many academics, he was “covered in coal dust” – he was the chair or a director of his local NHS organisations for more than 20 years.

His willingness to throw a match into any passing box of fireworks won him adoring fans. But it also made him enemies. To some he seemed just flippant, a trouble-maker. And he could overdo it. But behind the barbs was almost always a kernel of truth that even those who were wounded could come in time to recognise. Many who mattered most always recognised his value – the Department of Health, the Commons health select committee, the World Bank and the World Health Organisation were just some of those who called in his wisdom as well as his wit.

For behind the irreverence, the alliance building and the provocation was a serious intent – a profound moral belief that it was everyone’s duty to get the best value out of healthcare expenditure. The incentives and vested interests that stood in the way of that had to be challenged. Better incentives had to be found. The success of healthcare had to be measured by its outcomes, not its inputs – and that included the then revolutionary idea that patients themselves, not the just the clinicians, should be asked systematically whether their operation had in fact proved a success. For all that and more, modern healthcare owes him much. Maynard’s manoeuvres were masterful. And indeed a success.

He is survived by Liz and their children, Justin, John, Jane and Samantha, and his older sister, Jean.

Alan Keith Maynard, health economist, born 15 December 1944; died 2 February 2018

Alan Maynard obituary

Health economist who had a major impact on policy and practice

Alan Maynard was a great communicator and intellectual agent provocateur


Alan Maynard was a great communicator and intellectual agent provocateur

Alan Maynard, emeritus professor of health economics at the University of York, who has died aged 73, was crucial in the development of his discipline into an international profession. He also had a real impact on policy, not just in the UK.

He was, for example, an originator of the idea that better value for money and better outcomes might be achieved if family doctors were given budgets with which to buy their patients’ care. He was an early and public advocate of the principle that, before the NHS paid for them, drug companies should have to show that their new products were not just clinically effective but cost-effective. That idea resulted in the creation in 1999 of Nice, the National Institute for Health and Care Excellence, a model that other countries have adopted and adapted.

Few would have predicted such an impact for the slightly scrawny kid growing up in postwar Bebington in Cheshire, the son of Edward Maynard, a shoe buyer, and his wife, Hilda (nee McCausland). “He hated school and didn’t really learn to read properly until he was nine,” according to Elizabeth Shanahan, whom Maynard met as a teenager and married in 1968, in one of the few conventional acts of his life. “The world was in revolt,” Liz recalled, “but we got married with lots of bridesmaids and Pyrex casseroles.”

He had scraped into the local grammar school, only to be told bluntly that he would never get to university. But two A-levels took him to Newcastle, initially to do accountancy – “something he also hated” – before a switch to economics took him to the subject that, Liz said, quite simply made him. A second degree at York led to an assistant lectureship at Exeter University alongside Tony Culyer, an equally influential economist.

Back in the 1960s, few economists believed health was a subject fit for their high-minded attention. But Culyer and Maynard, along with Alan Williams, who recruited the pair to York – Maynard became lecturer in economics there in 1971 – are now seen as the founding fathers of health economics in the UK.

Once at York, Maynard created an MSc in the subject and then, in 1983 (the year in which he was appointed professor), established the Centre for Health Economics, which in turn produced “the York diaspora”. More than 750 of its graduates now work in governments, universities, pharmaceutical companies, health services and think tanks around the world. He was an inspirational teacher not just of economists but of medical students, who would find themselves facing questions such as “Is killing people wrong?” Lectures and supervisions were laced with irony, humour and challenge, but also kindness and compassion.

Maynard authored or co-authored more than 500 academic papers, was founding editor in 1992 of what is now the leading journal Health Economics, and in 2015 was awarded the Graham prize – the closest health services research gets to a Nobel prize. However, his role as a great communicator and intellectual agent provocateur was at least as important as his academic work. He wrote countless, often irreverent, media columns, and engaged endlessly with journalists, because, to paraphrase his guide on how to get research translated into action, “you have to find your allies anywhere and everywhere”.

He spent a good chunk of his life hurling squibs of wit and doses of wisdom at the great, the good, and the misguided in the world of healthcare. Politicians were criticised for faith-based rather than evidence-based policy, and for failing to evaluate what they did. The august medical royal colleges were accused of taking taxpayer funded grants but failing to protect patients. The stricture that the NHS has been subject to repeated “re-disorganisation” is almost certainly Maynard’s. And he knew all about that, because, unlike many academics, he was “covered in coal dust” – he was the chair or a director of his local NHS organisations for more than 20 years.

His willingness to throw a match into any passing box of fireworks won him adoring fans. But it also made him enemies. To some he seemed just flippant, a trouble-maker. And he could overdo it. But behind the barbs was almost always a kernel of truth that even those who were wounded could come in time to recognise. Many who mattered most always recognised his value – the Department of Health, the Commons health select committee, the World Bank and the World Health Organisation were just some of those who called in his wisdom as well as his wit.

For behind the irreverence, the alliance building and the provocation was a serious intent – a profound moral belief that it was everyone’s duty to get the best value out of healthcare expenditure. The incentives and vested interests that stood in the way of that had to be challenged. Better incentives had to be found. The success of healthcare had to be measured by its outcomes, not its inputs – and that included the then revolutionary idea that patients themselves, not the just the clinicians, should be asked systematically whether their operation had in fact proved a success. For all that and more, modern healthcare owes him much. Maynard’s manoeuvres were masterful. And indeed a success.

He is survived by Liz and their children, Justin, John, Jane and Samantha, and his older sister, Jean.

Alan Keith Maynard, health economist, born 15 December 1944; died 2 February 2018

Alan Maynard obituary

Health economist who had a major impact on policy and practice

Alan Maynard was a great communicator and intellectual agent provocateur


Alan Maynard was a great communicator and intellectual agent provocateur

Alan Maynard, emeritus professor of health economics at the University of York, who has died aged 73, was crucial in the development of his discipline into an international profession. He also had a real impact on policy, not just in the UK.

He was, for example, an originator of the idea that better value for money and better outcomes might be achieved if family doctors were given budgets with which to buy their patients’ care. He was an early and public advocate of the principle that, before the NHS paid for them, drug companies should have to show that their new products were not just clinically effective but cost-effective. That idea resulted in the creation in 1999 of Nice, the National Institute for Health and Care Excellence, a model that other countries have adopted and adapted.

Few would have predicted such an impact for the slightly scrawny kid growing up in postwar Bebington in Cheshire, the son of Edward Maynard, a shoe buyer, and his wife, Hilda (nee McCausland). “He hated school and didn’t really learn to read properly until he was nine,” according to Elizabeth Shanahan, whom Maynard met as a teenager and married in 1968, in one of the few conventional acts of his life. “The world was in revolt,” Liz recalled, “but we got married with lots of bridesmaids and Pyrex casseroles.”

He had scraped into the local grammar school, only to be told bluntly that he would never get to university. But two A-levels took him to Newcastle, initially to do accountancy – “something he also hated” – before a switch to economics took him to the subject that, Liz said, quite simply made him. A second degree at York led to an assistant lectureship at Exeter University alongside Tony Culyer, an equally influential economist.

Back in the 1960s, few economists believed health was a subject fit for their high-minded attention. But Culyer and Maynard, along with Alan Williams, who recruited the pair to York – Maynard became lecturer in economics there in 1971 – are now seen as the founding fathers of health economics in the UK.

Once at York, Maynard created an MSc in the subject and then, in 1983 (the year in which he was appointed professor), established the Centre for Health Economics, which in turn produced “the York diaspora”. More than 750 of its graduates now work in governments, universities, pharmaceutical companies, health services and think tanks around the world. He was an inspirational teacher not just of economists but of medical students, who would find themselves facing questions such as “Is killing people wrong?” Lectures and supervisions were laced with irony, humour and challenge, but also kindness and compassion.

Maynard authored or co-authored more than 500 academic papers, was founding editor in 1992 of what is now the leading journal Health Economics, and in 2015 was awarded the Graham prize – the closest health services research gets to a Nobel prize. However, his role as a great communicator and intellectual agent provocateur was at least as important as his academic work. He wrote countless, often irreverent, media columns, and engaged endlessly with journalists, because, to paraphrase his guide on how to get research translated into action, “you have to find your allies anywhere and everywhere”.

He spent a good chunk of his life hurling squibs of wit and doses of wisdom at the great, the good, and the misguided in the world of healthcare. Politicians were criticised for faith-based rather than evidence-based policy, and for failing to evaluate what they did. The august medical royal colleges were accused of taking taxpayer funded grants but failing to protect patients. The stricture that the NHS has been subject to repeated “re-disorganisation” is almost certainly Maynard’s. And he knew all about that, because, unlike many academics, he was “covered in coal dust” – he was the chair or a director of his local NHS organisations for more than 20 years.

His willingness to throw a match into any passing box of fireworks won him adoring fans. But it also made him enemies. To some he seemed just flippant, a trouble-maker. And he could overdo it. But behind the barbs was almost always a kernel of truth that even those who were wounded could come in time to recognise. Many who mattered most always recognised his value – the Department of Health, the Commons health select committee, the World Bank and the World Health Organisation were just some of those who called in his wisdom as well as his wit.

For behind the irreverence, the alliance building and the provocation was a serious intent – a profound moral belief that it was everyone’s duty to get the best value out of healthcare expenditure. The incentives and vested interests that stood in the way of that had to be challenged. Better incentives had to be found. The success of healthcare had to be measured by its outcomes, not its inputs – and that included the then revolutionary idea that patients themselves, not the just the clinicians, should be asked systematically whether their operation had in fact proved a success. For all that and more, modern healthcare owes him much. Maynard’s manoeuvres were masterful. And indeed a success.

He is survived by Liz and their children, Justin, John, Jane and Samantha, and his older sister, Jean.

Alan Keith Maynard, health economist, born 15 December 1944; died 2 February 2018

Alan Maynard obituary

Health economist who had a major impact on policy and practice

Alan Maynard was a great communicator and intellectual agent provocateur


Alan Maynard was a great communicator and intellectual agent provocateur

Alan Maynard, emeritus professor of health economics at the University of York, who has died aged 73, was crucial in the development of his discipline into an international profession. He also had a real impact on policy, not just in the UK.

He was, for example, an originator of the idea that better value for money and better outcomes might be achieved if family doctors were given budgets with which to buy their patients’ care. He was an early and public advocate of the principle that, before the NHS paid for them, drug companies should have to show that their new products were not just clinically effective but cost-effective. That idea resulted in the creation in 1999 of Nice, the National Institute for Health and Care Excellence, a model that other countries have adopted and adapted.

Few would have predicted such an impact for the slightly scrawny kid growing up in postwar Bebington in Cheshire, the son of Edward Maynard, a shoe buyer, and his wife, Hilda (nee McCausland). “He hated school and didn’t really learn to read properly until he was nine,” according to Elizabeth Shanahan, whom Maynard met as a teenager and married in 1968, in one of the few conventional acts of his life. “The world was in revolt,” Liz recalled, “but we got married with lots of bridesmaids and Pyrex casseroles.”

He had scraped into the local grammar school, only to be told bluntly that he would never get to university. But two A-levels took him to Newcastle, initially to do accountancy – “something he also hated” – before a switch to economics took him to the subject that, Liz said, quite simply made him. A second degree at York led to an assistant lectureship at Exeter University alongside Tony Culyer, an equally influential economist.

Back in the 1960s, few economists believed health was a subject fit for their high-minded attention. But Culyer and Maynard, along with Alan Williams, who recruited the pair to York – Maynard became lecturer in economics there in 1971 – are now seen as the founding fathers of health economics in the UK.

Once at York, Maynard created an MSc in the subject and then, in 1983 (the year in which he was appointed professor), established the Centre for Health Economics, which in turn produced “the York diaspora”. More than 750 of its graduates now work in governments, universities, pharmaceutical companies, health services and think tanks around the world. He was an inspirational teacher not just of economists but of medical students, who would find themselves facing questions such as “Is killing people wrong?” Lectures and supervisions were laced with irony, humour and challenge, but also kindness and compassion.

Maynard authored or co-authored more than 500 academic papers, was founding editor in 1992 of what is now the leading journal Health Economics, and in 2015 was awarded the Graham prize – the closest health services research gets to a Nobel prize. However, his role as a great communicator and intellectual agent provocateur was at least as important as his academic work. He wrote countless, often irreverent, media columns, and engaged endlessly with journalists, because, to paraphrase his guide on how to get research translated into action, “you have to find your allies anywhere and everywhere”.

He spent a good chunk of his life hurling squibs of wit and doses of wisdom at the great, the good, and the misguided in the world of healthcare. Politicians were criticised for faith-based rather than evidence-based policy, and for failing to evaluate what they did. The august medical royal colleges were accused of taking taxpayer funded grants but failing to protect patients. The stricture that the NHS has been subject to repeated “re-disorganisation” is almost certainly Maynard’s. And he knew all about that, because, unlike many academics, he was “covered in coal dust” – he was the chair or a director of his local NHS organisations for more than 20 years.

His willingness to throw a match into any passing box of fireworks won him adoring fans. But it also made him enemies. To some he seemed just flippant, a trouble-maker. And he could overdo it. But behind the barbs was almost always a kernel of truth that even those who were wounded could come in time to recognise. Many who mattered most always recognised his value – the Department of Health, the Commons health select committee, the World Bank and the World Health Organisation were just some of those who called in his wisdom as well as his wit.

For behind the irreverence, the alliance building and the provocation was a serious intent – a profound moral belief that it was everyone’s duty to get the best value out of healthcare expenditure. The incentives and vested interests that stood in the way of that had to be challenged. Better incentives had to be found. The success of healthcare had to be measured by its outcomes, not its inputs – and that included the then revolutionary idea that patients themselves, not the just the clinicians, should be asked systematically whether their operation had in fact proved a success. For all that and more, modern healthcare owes him much. Maynard’s manoeuvres were masterful. And indeed a success.

He is survived by Liz and their children, Justin, John, Jane and Samantha, and his older sister, Jean.

Alan Keith Maynard, health economist, born 15 December 1944; died 2 February 2018