Professor John Starr 1960-2018

16 January 2019

Professor John Starr died suddenly on 8th December, 2018, aged just 58.

He graduated in Medicine from Cambridge and King’s College, London, including a History of Fine Arts degree. He came to Edinburgh as a research fellow in the Department of Psychiatry in 1989, investigating the relationship between blood pressure and cognition. After returning briefly to the renowned Hammersmith Hospital, London, he was appointed as consultant and part-time Senior Lecturer in Geriatric Medicine at the Royal Victoria Hospital in Edinburgh, and soon thereafter was promoted to an honorary Chair – Professor of Health and Ageing – at the University of Edinburgh.

He was a clinical academic, working as a consultant physician in Geriatric Medicine at the Royal Victoria Hospital and the Western General Hospital in Edinburgh. His skills as a physician were in his breadth and depth of knowledge. On ward rounds, he would give the patient his full attention and focus on what mattered to them, whilst also mulling over the bigger picture and imparting valuable clinical facts and unusual life anecdotes.

His approach could be infuriating for ‘task oriented’ junior doctors, but there never failed to be a moment on his ward round when an unexpected gem appeared. His focus was what was best for each individual, and he made no apologies for always putting his patients first. When the new Royal Victoria Building was designed, he ensured that there was a safe outdoor space adjacent to his ward where people could enjoy the outdoors without concerns of getting lost, or exposed to traffic.

Many current students and doctors in training, and those who are now consultants themselves, were strongly influenced by John and carry his lessons and example with them. Who else would start a ward round with a review of a poem; or theme an entire ward round on collagenous diseases; or use only Renaissance paintings as the slides for an academic talk; or illustrate a complex MRI technique with an analogy using a mattress and a wine glass?

His specialist interest was in dementia care, particularly for those with associated complex physical diseases. His particular passion was improving the care for older adults with intellectual disabilities, including adults with profound and multiple learning disabilities, which he did with compassion, humour, and immense enthusiasm.

His academic interests were broad and he had a wide-ranging interdisciplinary portfolio of research based around improving the understanding of cognitive ageing, dementia, and intellectual disability. His approach to questions was never restricted by traditional disciplinary boundaries, or conventional methods, and he had a particular talent for bringing novel approaches to questions. Areas of research that he explored included using routinely collected data to understand the environmental epidemiology of dementia; the use of MR elastography to understand differences in brain structure and function; mathematical modelling to map the spread of Clostridium difficile infection; item response theory to simplify functional decline scales; noticing that brain imaging would include measures of neck muscles and so could study sarcopenia; realising that birth records could allow investigation of early life risk factors for cognitive decline; considering the use of hair samples, dental records or hat size measurements to consider early life determinants of health; and in an early paper estimating genetic relatedness between individuals by counting the number of great-grandmothers they shared.

He co-founded Units that have had a huge influence across the academic world and have improved the health of people throughout Scotland and beyond. He was Co-Director of the Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), and his longstanding partnership with Professor Ian Deary was exemplary in demonstrating the synergy of their complementary skills in developing novel ideas and approaches. Their work, with Prof Lawrence Whalley of University of Aberdeen, on the Lothian and Aberdeen Birth Cohorts of 1921 and 1936 led to the novel field of ‘cognitive epidemiology’ and many high impact papers. The cohorts were highly engaged in the study, and the first to hear of the results, and they have featured in many TV programmes, newspaper articles and public lectures. John and Ian’s vision is an exemplar of engaging and retaining cohort study participants and sharing the results in novel ways; for example at a Football and Dementia summit, and in his role as advisor to the Edinburgh International Science Festival.

His work on the relationship between physical and mental health with Ian Deary and Lawrence Whalley was recognised by the prestigious Tenovus Scotland Margaret MacLellan Award in 2006.

John was always the voice asking ‘how will this help clinically?’ He was also founding Director of the Alzheimer Scotland Dementia Research Centre, Co-Director of the Scottish Dementia Clinical Research Network, on the Steering Committee for the Centre for Dementia Prevention, the Steering Group for Dementias Platform UK, and the professional advisory board of Playlist for Life (his own playlist is here).

He was an active BGS member, member of the BGS Education & Training Committee and the Dementia and related disorders Special Interest Group. He chaired the organising committee for the BGS Spring meeting in Edinburgh in 2010 on “Age of Enlightenment.”

He was an Alzheimer Scotland trustee for many years, and an Executive Member. He was also a proud member of the William Morris Society, which aims to perpetuate the memory of this 19th Century designer, craftsman, poet and socialist, with a robust and generous personality, creative energy and courage. This link continued John’s interest that began when he studied History of Art, and which inspired him to work across traditional disciplinary divides.

John was a member of The International Organization for Septuagint and Cognate Studies, which aims to promote research in, and the study of, Greek and other ancient translations of the Hebrew Scriptures. He was a Trustee of Faith in Older People, Scotland, which believes spiritual care is broader than any one faith or religion, and is of relevance to everyone.

His faith, and inclusivity, were some of his key hallmarks. Many of his interests outside work were related to this, and most of his colleagues did not know that he was a lay reader in the Scottish Episcopal Church, and with his wife Claire, a regular Sunday school teacher.

He was an expert on Biblical languages, including Hebrew and Aramaic, and the Dead Sea Scrolls, and taught classes in New Testament Greek with the Scottish Episcopal Institute. He completed a PhD in 2013 in the School of Divinity at the University of Edinburgh on the "Quantitative Analysis of the Aramaic Qumran Texts" which he completed in his spare time.

He wore his success and reputation lightly; as he noted himself earlier this year:

I’ve been in research for nearly thirty years, direct and co-direct research centres, held tens of millions of pounds in grants, published more than 400 original papers including in all those favourite journals Nature, Science, NEJM, Lancet, BMJ, PNAS etc etc, have a Google Scholar h-index of 85, sit on and contribute evidence to NICE and the WHO, but when all this is considered, the impact I feel best about is inspiring a sense of wonder.”

His words in this blog which he wrote for the BGS following discussions about the point of research – to inspire a sense of wonder - with one of his many PhD students, has provided comfort and guidance to those who are missing his wise words and cheerful presence. 

For me living isn’t about accumulating a list of achievements, or “impacts” as they might be termed, to be read out as a eulogy at my funeral. No, living is about being alive, that sequence of moments strung together from cradle to grave; and moments which inspire me with a sense of wonder, however ephemeral, are when I feel really alive. Research, suddenly seeing things revealed, just like moments when relationships deepen and transform, is able to bring such wonder into our lives.”

His presence and lessons will remain with us: no one who trained with or worked with John, sat with him in a meeting, or who received his insightful – though illegible – comments on their draft manuscripts could fail to be influenced by such a unique, knowledgeable, perceptive, kind and gentle soul. His gentleness was, however, combined with a steely determination: he would never be bullied or intimidated, standing firmly for his ideas, and continually questioning. He was a key influence and guide into clinical research for many, and the sage voice we would turn to in times of doubt. One of his greatest gifts was his ability to truly nurture and mentor his trainees, including his influence during his time as Training Programme Director for South East Scotland. He will be missed terribly, and we only hope to continue to live the lessons he shared with us, and enjoy his sense of wonder in the world.

Our deepest condolences are with his wife Claire and his sons John, Robert, Toby and daughter Gabriel, and his wider family and friends. A Thanksgiving Service to celebrate his life on Friday 4th January, 2019 in St Mary's Cathedral, Edinburgh was attended by over 300 people.

-Dr Susan Shenkin and Dr Conor Maguire