E-Drug: In memoriam: Professor Emeritus Per Knut M. Lunde
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[You are welcome to provide your own memories. Or contact me for additional
information/references as 'old days like this' is not so available online.
KM]
On 6 April 2022 E-drug published an obituary on Ernst Lauridsen, who was the first director of the 'real' WHO Drug Action Programme (DAP) in Geneva,
established in 1982
(http://lists.healthnet.org/archive/html/e-drug/2022-04/msg00002.html).
We have now lost another great champion. Professor Emeritus in clinical
pharmacology, Per Knut M. Lunde, passed away in his sleep in the early
morning of 26 June 2022. He would have turned 88 years on 11 July.
Dr Lunde was committed to promoting the essential drugs concept, to rational use of drugs (RUD), drugs and therapeutics committees, and to safety of medicines. During the years until he retired in 1998 he undertook around 70 assignments for WHO Geneva and the different regional offices. He has been adviser to health authorities and universities in around 40 countries to promote primary health care and use of essential medicines.
In a report to the 28th World Health Assembly in 1975, WHO addressed the
concern of rational drug use in developing countries and it was then that
the idea of an essential drug list (EDL) was born. Per Knut attended the
first informal consultation on the subject organised by DAP in October 1976, having been 'recruited' by DG Hiroshi Nakajima who was Secretary of the first Expert Committee on Essential Drugs at that time. Other non-WHO members at the meeting were Silvio Garattini and Gianni Tognoni (Italy), Ivan Darmansjah (Indonesia), and Norbert Hirschhorn (USA).
In 1977 the Expert Committee on the Selection of Essential Drugs, of which Per Knut was a member, proposed an initial list.
In 1988 WHO turned 40 years. A number of publications were issued as a
result of essential medicines being the main topic at the World Health
Assembly in May 1988. It had taken around 12 years from the start in 1977 to reach this point. Per Knut hailed the result but expressed concern that the ethical criteria were influenced (weakened) by the pharma lobby. Only when Ernst Lauridsen was appointed head of the small DAP unit which was placed directly under DG Halfdan Mahler did the programme become action oriented.
In 1970, the Drug Utilisation Research Group (DURG) was established in
Geneva and had its first project meeting in Oslo in 1971. Many E-druggers
will have fond memories of DURG, INRUD and ICIUM and regret that the focus
on RUD has almost disappeared. DURG operated under the WHO Europe Office
until 1995 when disagreements caused the bond to be broken and a EURODURG
society was established in 1996 with close link to the International Society of PharmacoEpidemiology (ISPE).
Per Knut was also instrumental in the establishment of the ATC/DDD
methodology developed from 1970 as a tool for measuring drug consumption.
The methodology met resistance from certain players (industry, countries),
but in 2002 the codes were finally added to the WHO Essential Medicines
list. The WHO Collaborating Centre for ATC/DDD is in Oslo and has run
international training courses for decades (https://www.whocc.no/).
There is so much to be said about the contribution that Per Knut and the
colleagues mentioned by Hans Hogerzeil in his obituary on Ernst Lauridsen
made to the essential drugs concept. This obituary is only the tip of the
Iceberg. Per Knut taught students at home and abroad and supervised PhD
students - the three that I know well are Ingebjorg Baksaas (developing the
ATC/DDD methodology), Ingrid Matheson (drugs in breastmilk), and Mariatou
Tala Jallow from Gambia (the Essential Medicines Programme in Gambia
(around 1993)).
I have focussed this obituary on his international work. However, he also
contributed considerably to developing a better medicine policy in Norway on clinical trials, ethical criteria, and pharmacotherapy.
Professor Knut Naess established in 1964 the Institute for Pharmacotherapy and started small pilot projects with ADR monitoring in 1965. He was joined by Per Knut who became head of the Institute 1982 - 1998.
In 1988 I returned to Norway after three years as Principal Pharmacist in Botswana and that is when I got to know Per Knut really well and a close friendship developed.
I started as head of the unit for adverse drug reactions monitoring at the drug regulatory authority (NRA). Per Knut was chair of the advisory board for drug safety and I was the secretary. We had many safety issues to evaluate, including triazolam (Halcion).
That the NRA rarely followed, not even discussed, our recommendations made us so frustrated that Per Knut resigned and I left NRA for a job as clinical pharmacist for a few years. Per Knut retired in 1998, 64 years old. In his retirement he withdrew from his professional life and spent time at his beautiful family property researching family and local history and taking historical trips with his wife for as long as their health permitted.
So much good work, enthusiasm, and support for the essential drugs concept
from the mid 1970's gradually disappeared with the increasing influence of
the pharmaceutical industry from around 1990. Per Knut and I shared the
vision of access to primary healthcare and drug safety for all and so, like
me he was disappointed with the situation both internationally and in Norway after 'we' decided to implement the EU medicines directive in 1994. This was at a time when WHO tried to promote the Scandinavian/Northern European models of primary healthcare.
We had to abolish the need clause, lift the very successful monopoly on wholesaling and liberate the pharmacy sector. Without the financial support of the autonomous state wholesaler (NMD) we probably wouldn't have had an institute of pharmacotherapy, a robust system for drug utilisation and wouldn't have been able to fund a lot of important research. All three have suffered after 1994.
I admired Per Knut for his engagement in medicine issues and for always
sticking to his principles. His research into medicines 'essentiality' and
safety proved correct.
Pharmacists and medical doctors/pharmacologists in Norway have not always enjoyed a relationship with mutual respect. I'm grateful that Per Knut worked closely many pharmacists and that personally, we were fighting for the same goals. I'm also grateful that he recommended me to a position on essential medicines with UNICEF in New York in 1993. It gave me valuable insight into the organisation.
My thoughts are with his family, his wife Helene, his children and
grandchildren. Thank you Per Knut for friendship and for working so hard
towards a better world.
Ms Kirsten Myhr, MScPharm, MPH
Kongsberg, Norway
Email myhr[at]online.no