Remembering Valerie Beral (1946–2022)

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Valerie Beral first crossed my path in the early 1970s in Papua New Guinea (PNG). We were both members of a 10-person epidemiological survey team, headed by the late Ruthven Blackburn, Professor of Medicine at the University of Sydney. Valerie was a medical student with wide interests. We were based at a mission hospital at Baiyer River, where I had worked in 1968. Ruthven was interested in a unique form of liver disease among the Enga people in PNG’s Western Highlands district. He (accompanied by his wife, Ann Woolcock, a respirologist) and his survey team had visited every second January for 2 weeks or so for about a decade. My first impression of Val Beral was of a warm, blithe, highly intelligent, inquisitive and independent young woman. She was intrigued and undaunted by what was a very foreign environment. Each day, weather permitting, the survey team visited the mountain villages, taking their equipment and records with them. They conducted a roll call of local inhabitants, performed physical examinations and took blood samples. Enthusiasm for liver biopsies ran high, promoted by a local myth that the biopsies were removing bad worms! Val helped with all of the team’s work—carrying equipment on the hikes to and from the villages, conducting examinations and recording data. Her inquisitive nature, keen observation and willingness to ask tough questions were apparent, as was her easy temperament. In the evenings at the mission guest house, the team’s time was split between collating the day’s collected data and enjoying relaxed chatter, board games and reading. Val’s independent, hippy-esque spirit that I witnessed in PNG is further revealed in a story from my colleague Alistair Woodward, who recalls a formal university dinner held for a panel reviewing the work of a large university department in Brisbane. Val, the panel’s Chair, arrived at the restaurant barefoot. She explained cheerfully that she had lost her shoes somewhere on the flight from London—but never mind, she would buy replacements next morning! The dinner proceeded happily. Over the years, we met whenever Val visited Sydney and we caught up occasionally in Oxford. She shared her research findings from her immense international studies with Australian audiences with enthusiasm, and her presentations usually ran over time! She was a splendid role model for women in science in general and in epidemiology. She took an active interest in the health of Indigenous Australians and provided mentorship to several now prominent Australian epidemiologists. My last substantial interaction with Val concerned the IJE, when she was president of the International Epidemiological Association (IEA). I responded to the call for expressions of interest in the editorship, following on from George Davey Smith and Shah Ebrahim. This was a tense time in the history of the Journal, and Val applied herself with characteristic energy and clarity of purpose to stabilizing both the IEA and the Journal. We (the IJE) benefited from her strong support in the immediate years that followed. Her achievements, of course, were the stuff of legends. We have lost a wonderful colleague and a great friend. Photo courtesy of Emily Banks Stephen Leeder Valerie joined the Department of Epidemiology and Medical Statistics at the London School of Hygiene & Tropical Medicine (LSHTM) in 1971 as a research fellow. It is extraordinary to think that just a few years later in 1974, as a 28-year-old, she published in The Lancet the first compelling evidence that cervical cancer was due to a sexually transmitted infection (nearly a decade before the human papillomavirus was established to be the cause of most cervix cancers). Re-reading this paper, one sees Valerie’s trademark ingenuity and the clarity of thought and expression that characterized all her work. Throughout her scientific career, she promoted the importance of employing basic principles rather than getting swept away with unnecessary technical complexity. Those of us who were lucky enough to interact with her in the early stages of our own careers as staff or students at LSHTM remember her insistence on getting things right, as well as her encouragement and generosity. Writing a paper with Valerie, one got used to countless drafts, each one written to make the argument clearer, more succinct and more robust. At LSHTM, Valerie established EMU (the Epidemiological Monitoring Unit), the name reflecting her antipodean roots. She brought together a team, mainly women, from a wide range of disciplines to work on topical epidemiological issues of importance. The common theme that ran through much of the work in EMU (and later in Oxford) was women’s health; but her work at LSHTM also included studies of the aetiology of melanoma and the mortality and cancer incidence among radiation workers in the UK. After Valerie left in 1989 to go to Oxford, she retained strong links with LSHTM. This was at both an institutional and a personal level, always being kept in the picture by her husband Paul Fine (Professor of Communicable Disease Epidemiology) and other friends and colleagues. In 2006, she was awarded the LSHTM Donald Reid Medal, and in 2011 her special relationship with LSHTM was acknowledged by her becoming an honorary fellow. She is much missed. Photo courtesy of Alison Price David Leon and Pat Doyle I first met Valerie as a DPhil student at the University of Oxford in 2008, and she became my highly valued mentor, thoughtful neighbour and dear friend. Valerie contributed greatly to global population health, her greatest legacy being the Million Women Study of women’s health. It has clarified the relation of contraceptive treatment and hormone therapy for menopause with the risk of breast and other reproductive cancers. In determined pursuit of answers to important questions, she continued this work after retirement in 2019; her commitment and persistence were matched only by those of Professor Sir Richard Peto, with whom she worked closely. Valerie was an inspirational role model for women pursuing a career in science. She had intellectual curiosity in spades, but intellect without integrity didn’t cut it with her: she valued truth even when it was inconvenient or unpopular. Results were interrogated. Analyses were repeated. Papers were drafted and redrafted and, not infrequently, completely rewritten. She intuitively understood numbers and expressed her thoughts with clarity and candour. Working with Valerie was a boot camp in excellence, occasionally exhausting and exasperating, but ultimately a gift. Valerie embraced cultural difference. Her parents migrated to Australia from Eastern Europe (Bucovina). Valerie, in turn, came to the UK as a young doctor. Although she seemed to make the move from Australia with ease, first to London and then to Oxford, Valerie understood the challenge of providing a safe and welcoming space for migrants and people from diverse backgrounds. She cultivated an inclusive, open-door culture at work. She was strongly loyal, and many of her staff worked with her for more than 20 years. Valerie was warm, welcoming and generous. She loved to entertain and delighted in hosting supper at home, particularly if the visitors rolled up their sleeves to help prepare the meal, while she continued working on her research and calling out directives from her home office to Paul Fine, her husband, in the kitchen. I will forever treasure those times. Valerie was also a keen gardener. At her house in Oxford, where she spent the last decade of her life with Paul, she created a thriving English flower garden sprinkled with native Australian shrubs and trees. The golden wattle that Valerie planted in her back garden now towers, magnificent in yellow bloom, against a backdrop of giant oak, overlooking the spires of Oxford. During her life, Valerie had an overwhelmingly positive impact on those who knew her personally or benefited from the findings of her research. I h

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