A sad way to fire up the blog after a long summer break. My good friend and colleague, Bill Meadow, died a few days ago.

I first got to know Bill when I was junior faculty in Edmonton. At that time Bill was in Chicago as a young neonatologist who also did a fellowship in infectious diseases; we were both interested in hemodynamics, and using piglet models to investigate therapy. We would meet at what was then the SPR (society for pediatric research) and we would visit each others posters. When he came to mine I remember him saying “just tell me about the methods” so I would describe what we had done, and he would then predict what results we had found. He was, annoyingly, always right. In one meeting we were both presenting results of hemodynamic responses to group B streptococcus in newborn piglets, he was using live bacteria, and I was infusing killed ones. We had very similar results. He always wore, even in those early days (since 1984 or so), a distinctive leather hat, with a narrow brim. I guess it was sort of a lucky charm, and maybe a culture medium also! Our intermittent meetings were marked by the warmth of his personality and even though we only met academically, I started to think of him as a friend.

Bill’s subsequent research interests moved into bio-ethics, with his scientific approach, his piercing intellect, and his concern that babies get appropriate care, he was interested in data rather than opinions. One of his early ethics publications for example is this “Meadow WL, et al. Birth weight-specific mortality for extremely low birth weight infants vanishes by four days of life: Epidemiology and ethics in the neonatal intensive care unit. Pediatrics. 1996;97:636-43” where he described with good data that after a few days survival in the NICU, there was no longer a significant impact on mortality of the initial birthweight. The implication being that decision-making should be based on the baby’s current condition, and not differ between a “500 grammer” and a “900 grammer”.

One of his SPR podium presentations changed Annie Janvier’s career also, he had compared what obstetricians remembered about their own practice (with regard to giving antenatal steroids prior to preterm birth) with what actual practice had been. There were enormous discrepancies. At the same time Bill presented  data about how long it took to get antibiotics when a child presented with meningitis, compared to what the guidelines, and expert testimony say. The findings have implications for all sorts of expert witness testimonies; expert witness in malpractice cases should be based on facts not just opinions. The presentations so impressed Annie, that she went to ask him a question or two and he generously spent the next 90 minutes talking to her about her future, what she could research and how he could help her in the future. He became the co-supervisor of her bioethics PhD, and became a close friend to both of us.

Bill was someone who was generous, with his time and his expertise, compassionate, and completely intolerant of bullshit. Watching him moderate a discussion session was a delight, he would ask challenging questions with very straightforward language, and interrupt if you started to respond with high-blown ethical statements packed with acceptable euphemisms. He could re-phrase what you said and make you think about your underlying assumptions. Some people found that intolerable, he was even black-listed by one prestigious university hospital ethics group! One of the group that banned him had previously published an article containing this gem : “Phronetic comprehending calls for a creative construal of that which is meaningful (and meaning making) in a situation”. It seems for some people that clarity is a fault: not for Bill.

In contrast, people who are prepared to be pushed intellectually, challenged, and stimulated, rapidly grew to love him, many have continued to perform research in neonatal bioethics, which is much more evidence-based as a result of his efforts. There is an entire international network of Bill’s friends who continue to question orthodoxy, and who are themselves somewhat intolerant of b.s. and of mediocrity: the Bill Meadow diaspora.

In 2016, when we all knew he was sick, John Lantos organised a Festschrift for Bill, I presented a systematic review of the effects of a dose of Bill Meadow on a neonatal reserch subject. The conclusion was that a dose of Bill Meadow always clarified the situation, and improved care for babies. On one subject I disagreed a bit with the emphasis that he put on a particular outcome, so I quoted back to him one of his favorite phrases: “I love you Bill, but you’re wrong”. (He wasn’t often wrong).

His dedication to his patients was total, another of his simple, but important sayings was “Never abandon your patients”. No matter how tough it is, now matter how much you might disagree with parents, no matter how tired you are, always keep the babies at the centre of what you are doing. He was equally dedicated to his family, to his friends, and to his trainees (many of whom are happy to have become his friends).

Goodbye Bill, we miss you already.

https://www.uchicagomedicine.org/forefront/news/2019/september/william-meadow-obituary