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‘GREAT FEUDS IN MEDICINE: Ten of the Liveliest Disputes Ever’

2002; Wolters Kluwer; Volume: 24; Issue: 8 Linguagem: Inglês

10.1097/01.cot.0000289932.93516.ee

1548-4688

Ernst R. Jaffé,

Health and Conflict Studies

By Hal Hellman, John Wiley & Sons, New York City, Hardcover, 2001, 237 pages, $24.95FigureThe 10 chapters in this exhaustively referenced book by Hall Hellman, also the author of Great Feuds in Science, describe the trials and tribulations of nine men and one woman who were engaged in sometimes vicious controversies about discoveries in medical science over four centuries. The book presents a fascinating review of the torture that these scientists endured to get their concepts accepted or even considered by the “establishment.” Each of them may have been or is an alpha type with a large and often self-destructive ego. Serendipity played a major role in many of the cases. Theirs was often not the original observation, but these scientists were instrumental in ultimately obtaining recognition of the idea or principle involved. For example, the argument about who first discovered HIV will never be resolved for sure. Admittedly, Montagnier's isolate had contaminated Gallo's, and perhaps also visa versa. This imbroglio, however, involved many hours of argument and very expensive legal clashes. To maintain reasonably friendly relations between the United States and France, the American administration in 1994 agreed to share the royalties for the test for the virus. As Mr. Hellman concludes in that chapter, “Perhaps, some day, the experience of both men—and the outrageous response of many outsiders—will pay off by preventing another such incident from hindering a major, ongoing research project.” We will hope so! Breakthroughs & Battles The other chapters offer further proof that the path to medical progress is not always a smooth one. The book begins in 1628, when William Harvey offered the thesis that the heart circulates blood, as a rational explanation for how it moves through the body. The anatomists, however, preferred to continue to teach that blood is created in the liver, and moves from the heart to the rest of the body before disappearing in the tissues. Toward the end of Harvey's life, much of the intense criticism of his work abated and his theories saw ever greater acceptance. Nevertheless, it wasn't until four years after Harvey's death that the Italian physiologist Marcello Malpighi conducted microscopic studies to demonstrate the existence of the capillaries that make the interchange between venous and arterial blood possible. Today, it is impossible to believe that the washing of hands between ministering to different patients is not necessary. It was Ignaz Semmelweis who championed this simple procedure to prevent childbed fever in the 1850s. An English physician, as well as even Oliver Wendell Holmes, had written about the problem earlier, but members of the Viennese medical establishment ignored them. What's more, they looked down on the man they saw as a Hungarian interloper and resented his implication that their failure to wash their hands had killed untold numbers of patients over the years. Ironically, patients themselves saw Dr. Semmelweis's insistence on hand washing in the ward he ran as an insult. They believed it implied that they, not the hands of the doctors who treated them, were dirty.Figure: Reviewed by Ernst R. Jaffé, MD, Former Head, Division of Hematology, Albert Einstein College of Medicine, New York City (1970–1982); and Former Editor-in-Chief, Blood (1975–1977)Semmelweis was a sad bulldog of a man, perhaps bipolar. The author suggests that Semmelweis' years of struggle and rejection were very likely responsible for the severe mental breakdown he experienced toward the end of his life. He was committed to a mental institution, where he died in 1865 at the age of 47, apparently as the result of beatings he received there. The brilliant 19th century French physiologist Claude Bernard fought the earliest battles against the antivivisectionists. He was not only vilified by the anti-vivisectionists, but also by his colleagues who favored vitalism, a theory that held that animal functions depend on a special form of energy, the “vital” force, separate and distinct from physical forces. Bernard's great contribution was the introduction of experimental medicine with the application of science to the art of healing. “I know that physiology cannot possibly progress except by means of experiments on living animals, and I feel the deepest conviction that he who retards the progress of physiology commits a crime against mankind,” he wrote in 1881. Theories of Germs & Psychoanalysis “Prior to the mid-1880s, no physician ever cured a disease,” Mr. Hellman notes. The brilliant, multi-talented Louis Pasteur, a chemist, did not cure one, but he did introduce vaccination for rabies and pasteurization of milk as successful preventive measures. “More than anyone else, he showed that scientific research could pay off in the medical world,” Mr. Hellman writes. Pasteur insisted on promulgating the germ theory of disease, despite the opposition of many physicians. Even Robert Koch sneered at French microbiology and doubted the purity of the vaccine. Another conflict, the one between psychoanalytic theory and the thesis of the biochemical basis for mental illness, has never been resolved. It began 100 years ago with the publication of Sigmund Freud's The Interpretation of Dreams. “Freud, like Moses, gathered a group of faithful followers and took them into uncharted, unfamiliar territory,” Mr. Hellman writes, describing that frightening territory as “our own inner maelstrom, which had lain hidden from earliest times.” Freud's emphasis on the centrality of sexuality, especially infantile sexuality, drove early friends and foes, including Jung and Breuer, out of his camp. “Freud bashing” continues to this very day—By the 1990s it became what the author calls an industry—and it is unlikely that the battle will abate anytime soon. Sabin vs Salk The historic feud between Albert Sabin and Jonas Salk over whether an attenuated or killed vaccine provided the best protection against poliomyelitis was bitter and vocal. The controversy probably denied either man the Nobel Prize. It went instead to Enders, Weller, and Robbins in 1954 for growing the polio virus in human non-nerve tissue. Ultimately, the US government declared that an upgraded, stronger version of the Salk vaccine would be used, but it was Sabin's work that made the Salk vaccine victory possible. The chapter on Rosalind Franklin details another famous medical controversy—specifically over whose discovery came first. In this case the discovery in question is the double helix. Franklin's x-ray crystallographic studies provided the basis for the discovery in 1953 by Watson and Crick of the helical structure of DNA. She and Maurice Wilkins both worked at King's College in London and often shared information. Franklin died of cancer at age 37 in 1958, four years before Watson, Crick, and Wilkins received the Nobel Prize. James Watson himself has said that had she lived, Franklin would have shared the Nobel Prize with the three recipients. These 10 essays highlight the truism that scientific discoveries are built up from many different observations by numerous insightful people, often at about the same time. The scientists whose work is covered in this book suffered mental and physical ills because of their professional conflicts, but we are better off for their having persisted. Despite the author's wish for a more peaceable future, we can anticipate further feuds in science. The human genome project and Francis Collins vs J. Craig Venter comes to mind.