Diagnostic Imaging
July 2003

Special Edition 2003: The Global Face of Radiology
Profile

Philip Palmer champions radiology for have-nots
Radiology's 'conscience' seeks to raise imaging standards around the world

By: Sarah Jersild

As a passionate advocate for sharing the benefits of radiology with all who need it, no matter where they live, Dr. Philip Palmer has become the de facto conscience of radiology. Palmer has covered more ground during his 50-year-plus career than the most intrepid explorer. He has come a long way, literally, from his beginnings as a part-time radiologist and family practitioner in practice with his father in western England.

"I did radiology three or four half-days and did family practice, including rural house calls and delivering babies, for the rest of the time," he said.

When the newly created National Health Service mandated that he choose one specialty, Palmer selected radiology. In 1954, dissatisfaction with the NHS bureaucracy prompted him to take a job in what was then Southern Rhodesia (now Zimbabwe).

After 10 years in Rhodesia, Palmer moved to the University of Cape Town in South Africa, where he spent four years as director of radiology. In 1968 he accepted a position in the U.S. at the University of Pennsylvania, and in 1970 he became chair of the new department of radiology at the University of California, Davis. Palmer has trained countless radiologists and has contributed greatly to the field of tropical disease imaging.

But Palmer's career is defined by his tireless work in ensuring that the populations of the developing world will not be forgotten. He not only remembers the have-nots, he encourages others to do so, said Otha Linton, executive director of the International Society of Radiology.

"He doesn't think everybody ought to get on the airplane to go to Kenya, but he does think the radiological community ought to support those who can and will do that," Linton said.

Palmer vehemently rejects the notion that radiology isn't important for developing countries with many other health priorities.

"In our world, routine x-rays probably affect 50% of the diagnoses," he said. "For a person with a bad cough, a chest x-ray is vital. If you happen to be in the middle of Africa, good luck. If I had a fracture in one of these places, or a bad cough that wouldn't go away, and couldn't have a picture, I would be very upset. I take it for granted-the same way you take drinking good water for granted."

Palmer's work, attitude, and high expectations have gained him devoted fans throughout the world. Dr. Genny Scarisbrick, a radiologist who worked for two years at a teaching hospital in Ghana, corresponded with Palmer about difficult cases and asked for his help in preparing a training CD for the World Health Organization.

"One thing that has impressed me about him is that he expects standards to be high on the African continent just as he does elsewhere," Scarisbrick said. "I have come across so many people who think that anything is good enough or better than nothing. We need more people like Prof. Palmer to raise the standard of radiology in Africa. Why should they accept less?"

Palmer's visits to remote hospitals illuminated the differences between the practice of radiology in technologically advanced centers of the developed world and the isolated, primary-care health centers of Africa. The gap has continued to widen.

"A big problem is that the advisors to the ministers of health are usually highly trained professors, often with a private practice, whose whole idea is that the best thing for their country would be three CT scanners and a couple of linear accelerators," Palmer said. "They never go out to small hospitals; many of them haven't a clue what's happening."

That sort of high technology is useless in most areas of the developing world, he said. Besides being too expensive and nearly impossible to maintain, the more sophisticated equipment detects problems that simply can't be treated effectively. As a result, Palmer has become a vocal advocate of the WHO's World Health Imaging System for Radiology (WHIS-RAD), a simple, nearly indestructible piece of equipment that can meet almost all of a hospital's basic imaging needs.

The system is not more readily available, he said, because manufacturers are reluctant to produce and market a product that will not generate large profits.

"The major companies have never, ever advertised it. They are all mesmerized by MR and CT," Palmer said. "If two thirds of the world can't be x-rayed, and you have a simple solution, it really is quite wrong that the solution is blocked because a limited number of companies won't make as much profit as they'd like."

Palmer's efforts to spread the practice of radiology throughout the developing world have also included a long career as a consultant to the WHO. He has written several basic radiology textbooks for the organization and continues to edit and consult on new manuals.

He has also been instrumental in evaluating and setting up training programs. Palmer believes that it's worse than useless to send radiologists in developing countries to major academic centers in the developed world for training. Dr. Harald Ostensen, coordinator of Diagnostic Imaging and Laboratory Technology for the WHO, agrees.

"If people are taken out of their own countries, they won't go home. If they go back home, they won't haven't learned anything that they can use in their small district hospital with only one x-ray machine," Ostensen said.

Although Palmer sometimes appears critical, if not despairing, of his profession and career, he insists that's not the case.

"I've made a lot of friends and done some good, I think," he said.

Sarah Jersild is a freelance writer in Chicago.