It was one of those lovely, comfortable conversations between people who have known each other a long time. I took this selfie, and I’ll always treasure it.
It was the last time I saw Andrew Herxheimer.
His extraordinary life ended in February 2016. He was 90, and you wouldn’t think his death would come as a shock. But it did. Andrew was irrepressible and indefatigable. I still can’t quite believe he’s gone.
He would usually be first to that microphone in the aisle after a provocative conference presentation. He was a small guy with a large, clear, precise voice. You would hear him before you would see him: “Andrew Herxheimer, Cochrane Collaboration”.
Mention his name to someone even a little bit close to him, and a smile will break out. That’s part affection, and part Pavlovian response: wherever Andrew went among friends, laughter arrived quickly. This man’s impish humor and his sheer delight in making people laugh was irresistible.
Andrew was a clinical pharmacologist and activist, and of late a qualitative researcher at the University of Oxford. He taught me a great deal about the science of studying adverse effects of medicines. His voice always pulls me up when I catch myself about to say or write, “benefits and risks”. That, Andrew pointed out, assumes benefits are a given, and there’s only a chance of something going wrong. There are really only chances for both benefits and harms.
But the biggest impact he had on my life was a time the two of us talked earnestly into the night about things that lay beneath the visible surface of his life.
It was 2006. I was working in Cologne at a national German agency, IQWiG. That acronym is for the mouthful of long words that explains it’s the institute for assessing the quality and efficiency of health interventions. And I invited Andrew to visit us, and give a talk.
I didn’t know how Andrew felt about Germany. Andrew’s family had been refugees in the 1930s. His father had been a professor in Berlin. Someone once told me, Andrew could remember brownshirts threatening his father in the hallway of their home. That’s all I knew.
I didn’t know how my colleagues would react to Andrew. In my professional world outside Germany, he was well known and greatly admired. In the same circles in Germany, it turned out, he was revered.
Andrew went from meeting to meeting all day. Everyone wanted to talk to him. Once word went out he was coming, lots of people from outside wanted in, too.
His talk in the early evening was packed, and the mood was electric. There was a deep wave of mutual affection.
It turned out, Andrew was even more of a punster, if that’s possible, in German than English. And the laughter he got was far louder! Andrew was passionate about drug safety, and about qualitative research on people’s experiences of health care. As he engaged with this mostly young crowd about people’s suffering, in a room where only randomized studies were usually discussed, it felt transformative.
Late that night, he was buzzing, and wanted to keep talking. In a quiet bar, among the cobblestones of the old part of a very old town, we grappled with Germany’s history, and our own with it.
He was a child refugee. He was 12 when his family made it out to haven in England in 1938. I had migrated in from Australia in 2004. I’m first-generation Australian in a family that was half Germans, half Eastern European refugees.
Andrew had been telling me about how he started the Drug and Therapeutics Bulletin (DTB) in 1962. He had spent a year in the US, and was inspired by the Medical Letter for Drugs and Therapeutics. Andrew established DTB with the Consumers’ Association. It was part of his lifelong and influential involvement in the consumer movement around drug safety and access to medicines and information about them – and international collaboration around independent drug bulletins too.
That’s when he started talking about his father. His father was an eminent physiologist and professor of medicine. And he was so impressed with what Andrew was doing, that he started an independent drug bulletin for Germany in 1967, Der Arzneimittelbrief.
I don’t think I’ve ever heard of a father following in his son’s footsteps like that. I said that must have made him proud. Andrew nodded, smiled. Glowed with the pride of it.
I tucked away the thought, “I must find out more about Andrew’s father”. When Andrew died, I finally did.
His name was Herbert Herxheimer. And my first impression was how striking the similarities in their obituaries are. Highly regarded German-born doctors and scientists both. Both died in London “after a brief illness” at age 90. Extraordinary sense of humor mentioned front and center by their friends, who loved them dearly. Uncompromising about the truth. A thorn in the side of the drug industry, but respected by them, too.
Individual and collective histories shape our lives’ possibilities: and a science-y family is the biggest predictor of aspiring to a scientific career – with higher social class not far behind, and entangled with it [PDF]. Science is often a family story.
That was true for the Herxheimers. Their family tree of eminent scholars includes a rabbi and several medical scientists. There’s even an eponymous medical phenomenon: “Herxheimer reaction”, short for Jarisch-Herxheimer reaction – a drug adverse effect identified first by Adolf Jarisch and then by a great-uncle of Herbert’s, Karl Herxheimer.
Karl Herxheimer was a dermatologist and close colleague of Paul Ehrlich. They were among the prominent group of scholars and wealthy citizens who founded Frankfurt University in 1914. Herbert graduated from there. Its name was changed to Goethe University in 1932.
Herbert Herxheimer was born in Mainz in 1894. He had started studying medicine in Bonn, but that was interrupted by the First World War. He volunteered for the army, served as an officer on the Western front, and was decorated with the Iron Cross.
He specialized in internal medicine in 1924, and gained his scientific doctorate in Berlin in 1926. In between, Ilse, his wife, gave birth to Andrew, on 4 November 1925. They had a daughter, too, Eva.
Herxheimer studied the physiology of exercise and established one of the first sports medicine clinics. Here’s a table from a 1923 study of his on the effect of cycling on the size of the human heart. It compiles comparative data from other studies he did on body weight and heart size in different athletes.
The effect of exercise on the heart was his specific interest when he joined scientists from many countries studying athletes at the 1928 Amsterdam Olympics. Then he developed an enduring interest in the respiratory system. Herxheimer and a colleague have been credited with one of the key advances in respiratory physiology of exercise in 1932 – the relationship between breathing and carbon dioxide output during exercise transients.
He became a professor in 1932, too. And like several other Herxheimers, he wrote a major textbook in his field – exercise and sports medicine. There’s a 1933 review of it in JAMA:
Herxheimer’s excellent book deserves translation into English…
By then, his world was turning dark. He thought at first, though, that his field might do well with the new regime: exercise was central in Nazi ideology.
Hitler was appointed chancellor in January 1933; his party gained power with 33% of the vote in March. Jewish people could no longer hold public positions by law in April 1933. At first, war veterans who had served at the front, like Herxheimer, were exempt [PDF].
There was a big wave of people fleeing in 1933. About half of Germany’s Jewish doctors may have left the country at that point – mostly ones under 42. Academics were less likely to leave – and most of those who did, never gained academic positions again.
In Berlin, university students organized the giant book burning in May that year. Herxheimer kept giving lectures, although his position was downgraded, and his salary shrank. He could still give lectures during the winter semester of 1933/34, but Nazi staff scared off some students from attending. The announcements for his lectures were labeled. Then he wasn’t allowed to lecture in the main theater.
Persecution outside the university grew, and students started to attack their professors, too. Some were driven to suicide. In one lecture, students came up behind Herxheimer and pulled his chair out from under him. In June 1934, 12 medical students “rioted” at one of his lectures, preventing others from entering, hurling abuse and threats at him. Herxheimer complained: and was forbidden from using any lecture room in his department. So he kept lecturing in another part of the university.
A few weeks later, students attacked him again – this time physically. He took action again, lodging a complaint with the ministry of education. Three students got a warning from the university. Herxheimer would report in an interview for a 1967 television documentary on the response he received from the ministry. He was told:
“I regret these incidents, but I have to tell you, that you too lacked necessary restraint, as it would of course have been correct in these times, not to exercise your right to give lectures”.
Even the senior faculty who were not Nazis, like his own boss, he had also said, were willing to implement the new regulations against their colleagues. They worried about their own jobs and standing.
There is a report of a single member of the Berlin senior medical faculty who refused to sack colleagues. That was surgeon Rudolf Nissen. He left Germany the day after refusing to follow the directive.
In November 1934, Herxheimer’s teaching contract was terminated.
The Nuremberg laws limiting German citizenship on racial grounds came in September 1935. The bit of protection being a soldier at the front had provided was gone.
When he had to provide evidence about his racial heritage to the university, Herxheimer protested again, writing that he had been a volunteer at the front for 4 years; his parents, grandparents, and great grandparents had lived in Germany: “so that I have quite some right to regard this as my fatherland”.
In February 1936, the university announced the employment of all “non-Germans” would be terminated. Herxheimer became an unemployable emeritus professor.
Austria was annexed in March 1938 (Anschluss), and in July, doctors deemed “non-German” by the racial law lost the right to practice medicine with “Germans”. In October, Jewish people lost the right to own property and their passports were invalidated. Sometime that year, definitely before the pogroms started on Kristallnacht in November, Herxheimer, his wife, and children arrived in London.
Herxheimer’s famous great uncle, Karl, decided to stay in Frankfurt. In 1942, he and his partner were arrested, sent to Frankfurt’s ghetto, then deported to the Theresienstadt camp-ghetto. He died in a few months. His death certificate says 3 of his relatives were captive there, too.
Herbert Herxheimer’s lifeline to England came from Nobel Laureate and fellow physiologist, A.V. Hill. He was awarded the Nobel in 1922 for physiological work on muscle contraction, along with one of his German colleagues. Hill met Herxheimer at the 1928 Olympics in Amsterdam. He was studying cardiovascular physiology in athletes, too.
I’m not sure what happened to the Herxheimers between 1936 and the family’s arrival in London. Some time after the Anschluss, Hill got Herxheimer to England. His family followed later.
Back in April 1933, the day the university purge began, Hill was one of the academics mobilizing resources and working to remove barriers for displaced academics. The organization they formed in England then – based at the Royal Society – continues today as Cara (the Council for Assisting Refugee Academics). By the end of 1933 they had been able to place only a small fraction of Germany’s academic elite, though: 42. Each was supported with a stipend for a year at that point.
Hill and his colleagues faced an uphill battle with money, migration regulations, work permits – and resistance from universities and the medical profession that didn’t want competition for positions and income, and which sometimes themselves had racial restrictions.
Lord William Beveridge, the person who had initiated the organization, had what’s been described as an annus horribilis in 1933/34 at LSE because of it, clashing with both faculty and students.
In the end, the organization would rescue over 1,000 people, mostly after Kristallnacht.
This was the place where Hill was able to arrange a position for Herxheimer: Highgate School in North London.
Hill was one of the school’s governors. Herxheimer became the School Medical Officer and Supervisor of Physical Training. Hill’s advocacy also ensured that when the war started, Herxheimer was not interred as an enemy alien. And because of his father’s position at Highgate, Andrew could go to school there. The Herxheimers had to rebuild their lives, while struggling with the impact of displacement and fear for their family and friends back home, and a new marginality.
Andrew went, he said, from being bullied for being Jewish, to being bullied for being German. But father and son both ultimately thrived. Andrew was soon fluent in English, a member of the school’s science society, and secretary of the chess club. By 1942, Herbert Herxheimer was publishing in the medical literature again – in The Lancet about treating chilblains in students, and in the British Medical Journal about a pneumonia outbreak at the school.
Max Samter wrote in an obituary for his friend, Herbert:
It was not easy to make a living in England. He had to teach biology before he was granted a license to practice medicine. He returned to experimental immunology with the support of Sir Thomas Lewis.
Herxheimer worked on demonstrating the allergic nature of asthma. By 1952, he had published another textbook: this time in English, and on asthma. In 1955, he was among the first to study inhaled steroids for asthma in clinical practice.
In 1956, Herxheimer became one of the very few medical faculty expelled from Berlin to accept a position as professor there in the university’s restitution efforts. He was willing to go back to live in Germany?, I’d asked Andrew, surprised. “Never”. A curt, one-word answer. That anger throbbed, too, as Andrew talked of the family’s struggle with bureaucracy around reparations. And it drove a profound conviction in the importance of empathy and cooperation.
Herbert Herxheimer visited Germany frequently, but lived in London for the rest of his life. Andrew’s first return was soon after the war. He became an English citizen in 1946, and he served his time of national service in Germany as an interpreter. He received his medical degree from University of London in 1949 and went on to a distinguished and international career. He married twice, and had 2 daughters.
In his so-called retirement, Andrew dove into qualitative research. In an interview to commemorate his 90th birthday, he said (at 4:10, YouTube), interviewing people about painful parts of their lives was “like psychotherapy or psychoanalysis”:
In the process one learns more about being open oneself. Which is useful. And interesting. What we hide and why is very much part of being a complete person, isn’t it?
That night we talked in Cologne, Andrew explained that the hate and destruction he withstood in his youth fueled his commitment to internationalism, social justice, and activism. There was grace and strength in it. And wisdom that never stopped growing.
Vale, Andrew. Thank you.
* 4 Nov 1925 in Berlin. † 21 Feb 2016 in London.
RIP Andrew Herxheimer.
Doctor, writer, editor, lecturer, campaigner, friend.
Already the world feels a less interesting place.
— Andrew Herxheimer (@AHerxheimer) February 18, 2016
A Memorial Meeting for Andrew Herxheimer will be held by the University of Oxford at the Oxford Quaker House on 15 November 2016. Speakers include family and colleagues.
Andrew’s widow, Christine, and his daughters, Charlotte and Sophie, wrote an obituary for Andrew in the newsletter of the Association of Jewish Refugees [PDF, page 15].
Some of the many tributes and obituaries: The Guardian, The Lancet, BMJ, The Times, Health Action International, Health Talk, University of Oxford Department of Primary Care Health Sciences, UK Cochrane Centre.
A lifetime of international professional, policy, and activist achievement:
More than 200 publications in PubMed.
The Drugs and Therapeutics Bulletin, from its first issue in 1962, is here.
The international coalition of consumer unions, now Consumers International, formed its Health Working Group in 1978.
Health Action International was formed in 1981.
International Society of Drug Bulletins, formed in 1986.
The Cochrane Collaboration, formed in 1993.
The Cochrane Adverse Effects Methods Group, formed in 2000, formally registered in 2007.
The level of academics and students fleeing their homelands may be the highest it’s been since World War II. Organizations supporting academic refugees:
Cara: the Council for Assisting Refugee Academics
GCPEA: Global Coalition to Protect Education from Attack
The photo of the young boy in Europe (my son), the selfie with Andrew, and the photo of Andrew Herxheimer were taken by me (CC-NC-ND license). Translations from German are my own.
The logo of Goethe University Frankfurt via Wikimedia Commons.
The clipping of Herbert Herxheimer is from the British Medical Journal.
The photo of the Stolperstein memorial for Karl Herxheimer in Frankfurt is by Dr4Z in Wikimedia Commons.
The photo of the Chapel Quad at Highgate School in London is from 2006, by Lucho22 via Wikimedia Commons. (I cropped this photo to remove cars and people.)
(Cropped) photo of a street in the inner city of Cologne after bombing, June 1942. Photographer unknown. Via Wikimedia Commons.
* The thoughts Hilda Bastian expresses here at Absolutely Maybe are personal, and do not necessarily reflect the views of the National Institutes of Health or the U.S. Department of Health and Human Services.