Jonathan Shepherd

Shepherd's research career began as a research fellow in the Nuffield Department of Surgery at Oxford University (1978–79) where, leading to his Oxford MSc, he studied wound healing after cryosurgery under the supervision of Rodney Dawber. He discovered that the reasons low temperature injury resulted in little or no scarring was the preservation of the fibrous architecture of the dermis and resistance to low temperatures of fibroblasts.[4]

During a UK government Overseas Development Administration (Now DfID) secondment as a surgeon to the Ahmadu Bello University, Kaduna, Nigeria, he studied links between Epstein Barr Virus (EBV) and the jaw tumour prevalent in sub Saharan Africa, ameloblastoma. This research was inspired by the work of Denis Burkett who had found a causal link between this virus and lymphoma. Shepherd found no links with ameloblastoma apart from in immunocompromised patients.[5] After returning to his substantive surgical training post in Leeds in 1981 he donated the remaining serum samples from his research in Nigeria to Harald zur Hausen for his ongoing research on Human Papilloma Virus – work which would win zur Hausen the Nobel Prize for Physiology or Medicine.

Shepherd's surgical experiences in West Yorkshire (1980–3) brought about an interest in behavioural science and epidemiology. He observed that the miners' strikes in the Yorkshire Coalfield led to more people being injured in violence, and that a few pubs seemed to be the locations of hugely disproportionate numbers of violent incidents.

Following his appointment as senior lecturer and consultant oral and maxillofacial surgeon at Bristol University and the United Bristol Hospitals he completed his PhD, Assault; Characteristics of Injuries and Injured, awarded in 1988, supervised by Phyllida Parsloe and Crispian Scully. In these studies of consecutive patients injured in violence who attended the emergency department of the Bristol Royal Infirmary, Shepherd discovered that three-quarters of these incidents were not known to the police;[6] that these patients went through a bereavement process;[7] that their depression and anxiety levels remained much higher than in patients with similar injures but sustained in accidents rather than violence;[8] and that a previously unrecognised weapon type, glasses, had been used to inflict injury in 10% of cases.[9] These and other findings are the foundations of all Shepherd's research, policy development and impact on violence which followed.

After appointment as professor of oral and maxillofacial surgery and head of the department of oral surgery, medicine and pathology at the University of Wales College of Medicine (part of Cardiff University since 2004), Shepherd created the Violence Research Group and the Clinical Decisions Research Group.

Shepherd established the Clinical Decisions Research Group expressly to investigate decisions about wisdom teeth, the surgical removal of which, in the early 1990s, was one of only four surgical operations common to both top ten lists of UK in-patient and day case procedures. Working with Mark Brickley, he discovered that decisions to operate were being made almost at random;[10] that complication rates were far higher if these teeth were removed under general anaesthesia compared with local anaesthesia;[11] and that prophylactic removal resulted in worse outcomes for patients and less cost benefit than removal only after these teeth had become diseased.[12][13] These findings were instrumental in the mid-1990s in the substantial switch away from prophylactic surgery and removal under general anaesthesia on an in-patient basis, and also prompted the first guidelines and technology appraisal published by the then National Institute for Clinical Excellence (NICE) in 2000.

Prompted by his PhD and subsequent confirmation that police ascertain, at most, only 50% of violence which results in emergency treatment, and by public fears of violence, Shepherd, with Vaseekaran Sivarajasingam, founded the National Violence Surveillance Network (NVSN) of 120 hospital emergency departments across England and Wales. Since 2000, NVSN has published annual reports on violence. These demonstrate falling violence trends almost identical to those derived from the Office of National Statistics' Crime Survey of England and Wales, and attest to the unreliability of police records as a measure of violence. This new, hospital perspective, is of violence affecting all age groups and both genders and has done much to clarify violence trends and risks.[14]

Having discovered that many people are injured in violence where glasses are used as weapons and that glass fragmentation rather than whole glasses were the problem, Shepherd set about finding out which glass types were most frequently involved, and how they stood up to laboratory impact testing. A national survey showed that straight sided pint glasses (noniks) were used in three-quarters of these incidents[19] and, subsequently, that one particular pint glass product was much more impact resistant than all the rest.[20] Prompted by this finding Shepherd led a randomised trial of tempered pint glasses in pubs in the West Midlands and South Wales and concluded that tougher glasses were associated with a 60% lower injury risk compared with less impact resistant glasses.[21] In turn this prompted Shepherd to lead the Face of Wales campaign, supported by the Welsh Development Agency, for a switch to tempered glassware in the UK pub trade – a campaign which resulted in this change in the late 1990s, a change which Home Office statisticians estimated was associated with a reduction in glass assaults of around 47,000/year.[22]

Shepherd's discovery that the police were unaware of 50–75% of violence which results in hospital treatment – a finding since replicated in every Western country where this overlap has been studied – prompted him to hypothesise that emergency departments are sources of unique information which could be used to prevent violence more effectively than is possible using police intelligence alone. To test this idea, in 1996 he convened the Cardiff Violence Prevention Group (now Board). This group was a prototype Community Safety Partnership and was replicated by law across Britain in 1998. First, methods of collection in emergency departments of data on precise violence location, weapon, time and day and assailants were compared; electronic data capture by receptionists (termed registrars in the United States) proved most effective and sustainable.[23] Second, the use of these hospital data was trialled in the context of violence in pubs and nightclubs – and found to result in significantly greater prevention.[24] Third, a controlled experiment in 14 similar cities was carried out with collaborators at the Centres for Disease Control and Prevention (CDC) in the U.S; violence levels in the intervention city fell 42% more than in control cities.[25] Shepherd has attributed this decline in part to better targeted policing and an increased use of street CCTV. Fourth, an economic analysis concluded that cost benefit ratios were highly favourable; in Cardiff alone in 2007, savings were £6.9M compared with estimated costs in similar cities.[26] This evidence is central to the UK government's impact assessment of new public health measures which led to the decision to mandate multiagency violence prevention; this new law was announced in the December 2019 Queen's Speech to the UK parliament.[27]

By 2007, violent incidents in Cardiff had declined by 40%.[28] In 2009, the Cardiff Violence Prevention Group received the Queen's Anniversary Prize.[29]

This "Cardiff Model" was first implemented elsewhere in the UK in the late 1990s, starting in south east England, Merseyside and in Glasgow. In 2008, it was included in the UK government's alcohol strategy and in 2010 it was included in the new coalition government's programme.[30] By 2014 more than 60% of emergency departments were collecting and sharing Cardiff Model data and in 2016 this became mandatory in England. In 2017, the data were included in the new Emergency Care Data Set.[31] The Model has been endorsed by the World Health Organization,[32] adopted by the Centers for Disease Control and Prevention (CDC) for implementation in the United States,[33] and implemented in cities in the United States, Australia, South Africa and the Netherlands.[34][35]

Shepherd summarised the public health effectiveness of policing and criminal justice systems in an article in the Lancet.[36]

Working with Michael Harrison, Shepherd mapped head and face injuries sustained by cyclists,[56] and discovered that cycle helmet designs conferred little face protection.[57] Their published recommendation that helmet design should change to incorporate this protection was taken up a Formula One engineer, Matthew Jeffreys, who designed and patented the Face Saver helmet and worked with the Formula One driver, David Coulthard, to manufacture and market this new product.

Coulthard exhibited the prototype at the 2002 UK Motor Show. This new design was instrumental in bringing about a new generation of helmet designs, especially in mountain and other sports cycling disciplines.