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Monday March 30, 2020

Message from ASI President to membership

Dear ASI Members,

It is with great sadness that we inform our members of the passing of Professor Ian Mackay at the age of 98.

Professor Mackay was an ASI Honorary Life Member and is widely recognised as a pioneering Australian immunologist in the field of autoimmune disease.

With much gratitude, we would like to thank Len Harrison, WEHI, for the obituary below.

Ngā mihi

John Fraser, ASI President

Obituary written by Leonard Harrison, WEHI

It was with great sadness that we learnt of the death at the age of 98 on 24 March 2020 of the renowned clinician-scientist and immunologist, and alumnus of the Walter and Eliza Hall Institute (WEHI),

Professor Ian Reay Mackay AM FAA FRACP FRCP FRCPA.

Professor Ian Mackay in the 1960s.
His long-time research partner, Dr. Senga Whittingham, is standing in the background.

Ian was educated at the University of Melbourne, later training at Hammersmith Hospital, UK, with Dame Sheila Sherlock, a pioneer in the then-emerging field of hepatology. After working in the United States, in 1956 he was invited to work in Melbourne under Sir Ian Wood in the Clinical Research Unit, a joint initiative between WEHI and The Royal Melbourne Hospital.

Ian had laid foundations for the modern understanding of autoimmune diseases – conditions in which the body’s immune system mistakenly attacks its own organs and tissues. His legendary research led to the recognition of autoimmune diseases such as autoimmune hepatitis, lupus, rheumatoid arthritis and Sjögren’s syndrome, and to a new era of ‘immunosuppressive’ treatment for these diseases.

In the 1950s, the then Director of WEHI, and later Nobel Prize recipient, Sir Frank Macfarlane Burnet, had postulated that certain diseases might be caused by misdirected immunity to the body’s tissues - autoimmunity. At the time this was controversial – even derided – but Ian Mackay turned theory into practice. He observed that a laboratory test developed by Carlton Gajdusek (on sabbatical at WEHI) to demonstrate hepatitis A virus was actually detecting an autoimmune complement fixation reaction between human serum and liver. This test for autoantibodies in liver disease led to the description of autoimmune chronic active hepatitis. In 1957, Ian described another autoimmune liver disease, primary biliary cirrhosis, and 30 years later collaborated with Eric Gershwin and Ross Coppel to clone the gene for its autoantigen, mitochondrial M2.

Ian’s concepts about autoimmune disease in the 1950s and 60s were met with the usual scepticism (which I clearly remember as a medical student in the wilds of Sydney) - but Ian was above all tenacious. Eventually, as per Schopenhauer’s dictum that ‘All truth passes through three stages: first, ridiculed; second, violently opposed; third, accepted as being self-evident’, Ian was vindicated. Virtually every disease he predicted to be autoimmune in his seminal monograph Autoimmune diseases: pathogenesis, chemistry and therapy, with Burnet in 1963, is now accepted as such. He went on to pioneer the use of immunosuppressive life-saving steroids in the treatment of autoimmune hepatitis and other autoimmune diseases, and with Brian Tait and Peter Morris at the Royal Melbourne Hospital, was among the first to describe the associations between autoimmune diseases and HLA antigens. The Autoimmune Diseases was a landmark publication. In 2012, the Medical Journal of Australia commemorated the 50th anniversary of the book, describing it as “a founding text” that “marked the beginning of autoimmunity as a clinical science. Its insightful concepts and novel ideas inspired a generation of clinical and basic immunological researchers.1” Only in the last year did Ian in his meticulous manner put the finishing touches on the latest 6th edition of The Autoimmune Diseases, which contains contributions from many of us whom he mentored over the years. 

Ian headed the Clinical Research Unit from 1963 until his retirement in 1987, all this time making breakthroughs in the understanding and treatment of autoimmune diseases and publishing prolifically. He was a stellar role model for clinician-scientists and possessed a remarkable vigor and spirit of enquiry that we strive to emulate. After his retirement, he continued to mentor students and contribute to many productive research collaborations, from a research position at Monash University.

WEHI director Professor Doug Hilton AO paid tribute to Professor Mackay. “Ian was truly a scientific pioneer. We will remember his incisive mind, exacting standards and laser like focus on solving major clinical problems. He was a pioneer of the Institute’s commitment to translational research and shaped the Institute we have today. He will be greatly missed by his colleagues and friends.”

1. Roberts-Thomson, PJ, Jackson MW, Gordon TP. A seminal monograph: Mackay and Burnet’s Autoimmune Diseases. Medical Journal of Australia, 2012, 196(1):74-76.

Len Harrison,
Melbourne, March 2020

Being a unique individual, Ian was the subject of many anecdotes.

A Classic Anecdote about Ian Mackay

by Dr. Brian Youl – former clinical Registrar

Mackay caught me on the rebound from a disastrous first attempt at the Australasian College of Physicians Fellowship exam - I had confidently diagnosed cystic fibrosis in an elderly chap with chronic lung disease in the long case.  I went on to spend a year as Ian’s senior registrar in the Clinical Research Unit. 

Bizarrely, the highly talented Elsdon Storey was our junior registrar.  Sandwiched between these marvellous intellects I couldn't help but improve.  The Problem Oriented approach, while irritating in its rigour, as pursued relentlessly by Ian, nevertheless seemed to clarify my analysis of cases. Ian's ward rounds were more frightening than anything I was to encounter on my second and successful attempt at the Fellowship exam.

I will never forget the time on a Ward 3 East Round attended by, among others, two of the then authors of "Harrison's Textbook of Medicine", when, horrified at being asked to describe the mechanism of action of digoxin, I instantly dropped to the floor and underwent a grand mal convulsion. Ian, the consummate diagnostician, quite correctly recognised this to be a pseudoseizure, and stepped over me. He immediately turned to Storey and grilled him about the early works of Ovid. They went on to argue about the relative merits of Ovid’s 'Tristia' and 'Epistulae ex Ponto', while I hurriedly recovered. On reaching the next bed, I audaciously chipped in with some Australian culture: "What about Patterson, Dr Mackay?  You know, 'There was movement at the station, and the word had passed around'".  Ian glared at me and retorted, "The word had GOT around, Youl.  We'll move on, thank you!"

This demonstrates not only Ian’s broad clinical skills, extending well beyond autoimmune diseases, but his broad knowledge of both the ancient and modern classics.

The ten aphorisms of Ian Mackay

Collected by Alan Ebringer, Professor of Immunology at King's College London and Clinical Registrar in Ward 3 East, 1965.

 1: EVERY CHRONIC DISEASE IS AUTOIMMUNE UNLESS PROVED OTHERWISE.
 
2: IF YOU HAVE DONE ONLY 10 DRAFTS OF YOUR PAPER, THEN YOU HAVEN’T REALLY READ IT.
 
3: ONCE YOU HAVE DONE 20 DRAFTS, YOUR PAPER IS APPROACHING THE POINT OF SUBMISSION (My paper on "chloroquine neuromyopathy" went through 22 drafts.)
 
4: DO NOT QUOTE A PAPER IN YOUR REFERENCES THAT YOU HAVE NOT READ; SOONER OR LATER YOU WILL BE FOUND OUT.
 
5: AN ALCOHOLIC PATIENT IS USUALLY DOMINATED BY A STRONG WILLED MOTHER OR WIFE, AND SOMETIMES BOTH.
 
6: THERE IS NO SUCH THING AS A ROUTINE CASE; EVERY PATIENT CAN TEACH YOU GOOD MEDICINE.
 
7: YOU HAVE NO RIGHT TO PLAY "GOD" WITH INCURABLE DISEASES; YOU MUST DO YOUR BEST TILL THE END.
 
8: WHEN GIVING A RESEARCH TALK, REMEMBER THERE ARE ONLY TWO OR THREE PEOPLE IN THE AUDIENCE TO WHOM YOUR PRESENTATION IS ADDRESSED; THE OTHERS DON’T COUNT.
 
9: THE CONCEPT OF "EUTHANASIA" INTERFERES WITH CLEAR MEDICAL THINKING AND HAS BEEN BANISHED FROM MY WARD.
 
10: MOUSE IMMUNOLOGISTS USUALLY HAVE A POOR GRASP OF MEDICINE AND INEVITABLY WILL MAKE FOOLS OF THEMSELVES DURING WARD ROUNDS.