Category: Health

“Discovery Cannot Be Achieved by Directive”

(p. 170) As early as 1945 the medical advisory committee reporting to the committee reporting to the federal government on a postwar program for scientific research emphasized the frequently unexpected nature of discoveries:

Discoveries in medicine have often come from the most remote and unexpected fields of science in the past; and it is probable that this will be equally true in the future. It is not unlikely that significant progress in the treatment of cardiovascular disease, kidney disease, cancer, and other refractory conditions will be made, perhaps unexpectedly, as the result of fundamental discoveries in fields unrelated to these diseases…. Discovery cannot be achieved by directive. Further progress requires that the entire field of medicine and the underlying sciences of biochemistry, physiology, pharmacology, bacteriology, pathology, parasitology, etc., be developed impartially.

Their statement “discovery cannot be achieved by directive” would prove to be sadly prophetic.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: italics in original.)

“Folkman Persisted in His Genuinely Original Thinking”

(p. 141) As detailed by Robert Cooke in his 2001 book Dr. Folkman’s War, the successful answers to these basic questions took Folkman through diligent investigations punctuated by an astonishing series of chance observations and circumstances. Over decades, Folkman persisted in his genuinely original thinking. His concept was far in advance of technological and other scientific advances that would provide the methodology and basic knowledge essential to its proof, forcing him to await verification and to withstand ridicule, scorn, and vicious competition for grants. Looking back three decades later, Folkman would ruefully reflect: “I was too young to realize how much trouble was in store for a theory that could not be tested immediately.”

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: italics in original.)

Centrally Planned War on Cancer “Fails to Allow for Surprises”

(p. 115) It leaves the impression that all shots can be called from a national headquarters; that all, or nearly all, of the really important ideas are already in hand…. It fails to allow for the surprises which must surely lie ahead if we are really going to gain an understanding of cancer. –A COMMITTEE OF THE INSTITUTE OF MEDICINE, NATIONAL ACADEMY OF SCIENCES, ON THE NATIONAL CANCER ACT AND THE “WAR ON CANCER”

Source:
As quoted in Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: ellipsis in original.)

British Parents Jailed by Nationalized Health Service for Trying to Sell Home to Pay for Son’s Cancer Treatment

(p. A4) . . . , no Briton is ever entirely happy with the taxpayer-funded service, and now the case of a 5-year-old boy with a brain tumor has thrown a harsh light on the $170 billion-a-year system.
Critics are asking whether the service was justified in refusing a cancer treatment for the boy, Ashya King, sought by his desperate parents in an effort to save his life, and whether it overstepped in trying to impose its decision on his family.
The refusal set off a chain of events that enthralled and horrified the British public, as Ashya’s parents removed their son from University Hospital Southampton in England on Aug. 28 without the consent of British doctors, setting off a highly publicized international hunt. Concern for the child, however, turned into public outrage when the parents, Brett and Naghemeh King, were arrested and jailed in Madrid, where they had traveled to sell their holiday home so they could pay for the treatment, called proton beam therapy.
. . .
“They treated us like terrorists,” Mr. King, 51, said during an emotional news conference in Spain, where he and his wife were held for three days, separated from their critically ill son, as British authorities pursued University Hospital Southampton’s recommendation that Ashya be made a ward of the court.
. . .
(p. A10) Professor Hunter . . . said that, because the health service is publicly accountable, doctors tend to be reluctant to recommend innovative solutions for fear of lawsuits if things go wrong.
Mrs. Anderton, too, said that, despite the excellent care her son received, the N.H.S. is not always at the cutting edge. “The only downside is that we don’t have advanced types of treatments that could be lifesaving,” she said.

For the full story, see:
KIMIKO DE FREYTAS-TAMURA. “Health Care for Britain in Harsh Light.” The New York Times (Weds., SEPT. 17, 2014): A4 & A10.
(Note: ellipses added.)
(Note: the online version of the story has the date SEPT. 16, 2014.)

In Finding Cure for Ulcers, Marshall Was Not Constrained by the Need to Obtain Approval or Funding

(p. 113) Marshall was a youthful maverick, not bound by traditional theory and not professionally invested in a widely held set of beliefs. There is such a thing as being too much of an insider. Marshall viewed the problem with fresh eyes and was not constrained by the requirement to obtain approval or funding for his pursuits. It is also noteworthy that his work was accomplished not at a high-powered academic ivory tower with teams of investigators but instead far from the prestigious research centers in the Western Hemisphere.
The delay in acceptance of Marshall’s revolutionary hypothesis reflects the tenacity with which long-held concepts are maintained. Vested interests–intellectual, financial, commercial, status–keep these entrenched. Dogmatic believers find themselves under siege by a new set of explanations.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

Ideas Should Not Be Rejected Just Because They Disagree with Reigning Theory

(p. 107) . . . Claude Bernard, the nineteenth-century founder of experimental medicine, . . . famously said, “If an idea presents itself to us, we must not reject it simply because it does not agree with the logical deductions of a reigning theory.”

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: ellipses added.)

Fleck Made Two Versions of His Typhus Vaccine: A Worthless Version for the SS Troops and an Effective Version for His Fellow Buchenwald Inmates

(p. C7) Ludwik Fleck (1896-1961), who earned a doctorate at Lwów University while studying under Weigl, also became interested in typhus during World War I, when he too was drafted by Austria-Hungary. Fleck’s specialty was immunology, and in 1919 he joined Weigl’s institute. Somewhere between 1921 and 1923 he crafted a way to diagnose typhus, but despite this achievement, Polish anti-Semitism denied him the academic recognition that his talent merited. During this period, he would occupy government posts (until 1935, when anti-Semitic policies made it impossible for Jews to hold such positions) and, with his wife’s dowry, opened his own laboratory.
By August 1942, Fleck, though confined to Lwów’s Jewish ghetto, managed to create a vaccine from the urine of typhus patients. (Fleck’s vaccine may have been easier to produce than Weigl’s.) Six months later, he was sent to Auschwitz, where he worked in a bacteriological research unit and where he was treated somewhat better than most camp inmates. In December 1943, Fleck was dispatched to the Buchenwald concentration camp to work on a typhus vaccine.
The Germans wanted the Buchenwald typhus-vaccine prisoner unit–some were physicians and scientists, some weren’t–to follow instructions for making a vaccine that had originated at the Pasteur Institute in Paris. It was a convoluted process that involved rabbit lungs and the organs of other animals. The unit’s inmates, including Fleck, who understood immunology better than anyone else at Buchenwald, conspired to produce two kinds of vaccine: large quantities of worthless serum that were shipped to SS troops at the front; and much smaller doses of effective vaccine that were used to secretly immunize prisoners. Their daring sabotage could have led to their execution, of course, but their Nazi overseers in the camp were too medically ignorant to understand what was transpiring. If senior SS officials elsewhere became suspicious, the prisoners would supply the real vaccine for testing by the skeptical parties.

For the full review, see:
HOWARD SCHNEIDER. “The Fever that Gripped Europe.” The Wall Street Journal (Sat., July 19, 2014): C7.
(Note: the online version of the review has the date July 18, 2014, and has the title “Book Review: ‘The Fantastic Laboratory of Dr. Weigl’ by Arthur Allen; Two scientists who worked to beat typhus and sabotage the Nazis.”)

The book being reviewed:
Allen, Arthur. The Fantastic Laboratory of Dr. Weigl: How Two Brave Scientists Battled Typhus and Sabotaged the Nazis. New York: W. W. Norton & Company, 2014.

My dissertation adviser, Stephen Toulmin, recommended a philosophy of science book by Ludwig Fleck that I have owned for several decades, but never gotten around to reading. It is said to anticipate some of the issues discussed by Thomas Kuhn in his classic The Structure of Scientific Revolutions. The Fleck book is:
Fleck, Ludwik. Genesis and Development of a Scientific Fact. pb ed. Chicago, IL: University of Chicago Press, 1981 [first published in German in 1935].

Medical Innovator “Maintained a Healthy Skepticism Toward Accepted Wisdom”

(p. 103) Barry Marshall, a lanky twenty-nine-year-old resident in internal medicine at Warren’s hospital, was assigned to was assigned to gastroenterology for six months as part of his training and was looking for a research project. The eldest son of a welder and a nurse, Marshall grew up in a remote area of Western Australia where self-sufficiency and common sense were essential characteristics. His personal qualities of intelligence, tenacity, open-mindedness, and self-confidence would serve him and Warren well in bringing about a conceptual revolution. Relatively new to gastroenterology, he did not hold a set of well-entrenched beliefs. Marshall could maintain a healthy skepticism toward accepted wisdom. Indeed, the concept that bacteria caused stomach inflammation, and even ulcers, was less alien to him than to most gastroenterologists.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

“It Is Often Essential to Spot the Exceptions to the Rule”

Baruch Blumberg was awarded the Nobel Prize in 1976:

(p. 98) . . ., Blumberg learned an invaluable lesson: “In research, it is often essential to spot the exceptions to the rule–those cases that do not fit what you perceive as the emerging picture…. Frequently the most interesting findings grow out of the ‘chance’ or unanticipated results.”

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: ellipsis added.)

Variable Gene Expression Gives Us “Surprising Resilience”

(p. 11) As a physician who researches and treats rare genetic disorders, Sharon Moalem, the author of “Inheritance,” sees firsthand how sharply DNA can constrain our lives. Yet “our genes aren’t as fixed and rigid as most of us have been led to believe,” he says, for while genetic defects often create havoc, variable gene expression (our genes’ capacity to respond to the environment with a flexibility only now being fully recognized) can give our bodies and minds surprising resilience. In his new book, Moalem describes riveting dramas emerging from both defective genes and reparative epigenetics.
. . .
Moalem’s earthy, patient-focused account reminds us that whatever its promise, genetics yet stands at a humble place.

For the full review, see:
DAVID DOBBS. “The Fault in Our DNA.” The New York Times Book Review (Sun., July 13, 2014): 11.
(Note: ellipsis added.)
(Note: the online version of the review has the date July 10, 2014.)

Book under review:
Moalem, Sharon. Inheritance: How Our Genes Change Our Lives–and Our Lives Change Our Genes. New York: Grand Central Publishing, 2014.