Health – Page 97 – artdiamondblog.com

A Salute to the Sudanese Medicine Men

One might expect that the Sudanese medicine men mentioned below, might have undermined the British physicians, as potential competition. So either there is more to the story than is sketched below, or else these Sudanese medicine men in 1939 placed the mission of saving lives, above their own narrow short-run self-interest. If it was the later, then they deserve our belated salute.

(p. 236) Meningitis was a vicious disease. The death rate had always been high, and nothing they did had much effect. The British physicians concentrated on nursing the sick and trying to limit the spread of the disease. The only thing different this year came in the form of three small sample bottles of sulfa that had been sent to their clinic for the treatment of strep diseases and pneumonia. Strep diseases were not the problem of the moment in Wau. This meningitis was caused not by strep but by the more common cause, a related germ called meningococcus. Still, they had the new medicine, they had nothing else, and they had nothing to lose. Someone decided to try it on a meningitis patient.
. . .
(p. 237) . . . There were twenty-one patients in the first group. The doctors hoped to save at least a few of them.
A few days later, all but one were still alive. The physicians immediately wired for more sulfa. Once it arrived, one of the British doctors stayed at the hospital while the other two went village to village, administering sulfa to every meningitis patient they could find. They asked the help of local “medicine men,” as they called them, tribal healers whose dispensation was needed before the natives would accept treatment. The Sudanese healers knew how deadly the disease was. They told their people that the physicians had “magic in a bottle.” They told them to take the shots. The physicians traveled day and night, injecting patients in grass huts, under trees, and along roadsides, The results, they wrote, were “spectacular.” Within a few weeks, they treated more than four hundred patients. They saved more than 90 percent of them. They knocked out the epidemic before it could get started.

Inability to Patent Sulfa, Delayed Its Marketing

When new uses of old, unpatentable drugs are discovered, there seems to be inadequate incentive to publicize them, and bring them to market. (For example, I think I have seen research suggesting that aspirin and fish oil capsules, are as effective in fighting heart disease as some newer drugs, but are nonoptimally utilized because of perverse incentives.) Maybe a revision of the patent law should be considered that permits some patenting of new uses of old drugs and substances?

(p. 172) It was wonderful that this powerful, inexpensive medicine was now available, but for a year after the Pasteur Institute announcement, no one marketed it seriously in its pure form as a medicine. Because it was not patentable, it was difficult for major chemical or drug firms to see a way to make much of a profit from it. It was not until months after the Pasteur group’s first publication on sulfa that the president of Rhône-Poulenc, an industrial supporter of Fourneau’s laboratory, visited the Pasteur Institute to hear about it. After talking with the researchers he decided to launch Septazine, a variation on pure sulfa that he felt was different enough to allow patenting—and hence profits. Septazine reached the marketplace in May 1936.

French Entrepreneur Fourneau Was Against Law, But Used It

The existence and details of patent laws can matter for creating incentives for invention and innovation. The patent laws in Germany and France in the 1930s reduced the incentives for inventing new drugs.

(p. 141) German chemical patents were often small masterpieces of mumbo jumbo. It was a market necessity. Patents in Germany were issued to protect processes used to make a new chemical, not, as in America, the new chemical itself; German law protected the means, not the end. . . .
. . .
(p. 166) Fourneau decided that if the French were going to compete, the nation’s scientists would either have to discover their own new drugs and get them into production before the Germans could or find ways to make French versions of German compounds before the Germans had earned back their research and production costs—in other words, get French versions of new German drugs into the market before the Germans could lower their prices. French patent laws, like those in Germany, did not protect the final product. “I was always against the French law and I thought it was shocking that one could not patent one’s invention,” Fourneau said, “but the law was what it was, and there was no reasons not to use it.”

Christian Care “Replaced Roman Hygiene with Frequent Prayers and Infrequent Baths”

Hager discusses the medical practices of Paris’ Hôtel Dieu lying-in maternity hospital in the 17th century, that led to widespread, and often fatal, childbed fever:

(p. 114) Every day the senior doctors would arrive on their rounds followed closely by a gaggle of students. They would pull the women’s covers down, pass hands over their abdomens, point, prod, and discuss. Although the physicians’ wigs were carefully powdered, their hands were generally unwashed. Christian care, which emphasized purity of the soul over that of the body, had replaced Roman hygiene with frequent prayers and infrequent baths. In Paris the privies and slaughterhouses (as well as the hospital wards of the Hôtel Dieu) dumped their waste into the Seine, then drew drinking and washing water from the same source. Bedding was washed infrequently. Lice and fleas abounded.

Industrialist Duisberg Made Domagk’s Sulfa Discovery Possible

(p. 65) . . . Domagk’s future would be determined not only by his desire to stop disease but also by his own ambition, his family needs, and the plans of a small group of businessmen he had never met. He probably had heard of their leader, however, one of the preeminent figures in German business, a man the London Times would later eulogize as “the greatest industrialist the world has yet had.” His name was Carl Duisberg.

Duisberg was a German version of Thomas Edison, Henry Ford, and John D. Rockefeller rolled into one. He had built an empire of science in Germany, leveraging the discoveries of dozens of chemists he employed into one of the most profitable businesses on earth. He knew how industrial science worked: He was himself a chemist. At least he had been long ago. Now, in the mid-1920s, in the twilight of his years, his fortunes made, his reputation assured, he often walked in his private park alone—still solidly built, with his shaved head and a bristling white mustache, still a commanding presence in his top hat and black overcoat—through acres of forest, fountains, classical statuary, around the pond in his full-scale Japanese garden by the lacquered teahouse, over his steams, and across his lawns.

“Four G’s Needed for Success: Geduld, Geschick, Glück, Geld”

One of Domagk’s predecessors, in goal and method, was Paul Ehrlich, who was a leader in the search for the Zuberkugeln (magic bullet) against disease causing organisms. He systematized the trial and error method, and pursued dyes as promising chemicals that might be modified to attach themselves to the intruders. But he never quite found a magic bullet:

(p. 82) Ehrlich announced to the world that he had found a cure for sleeping sickness. But he spoke too soon. Number 418, also, proved too toxic for general use. He and his chemists resumed the search.

Ehrlich said his method consisted basically of “examining and sweating”—and his coworkers joked that Ehrlich examined while they sweated. There was another motto attributed to Ehrlich’s lab, the list of “Four Gs” needed for success: Geduld, Geschick, Glück, Geld—patience, skill, luck, and money.

Source:
Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor’s Heroic Search for the World’s First Miracle Drug. New York: Three Rivers Press, 2007.
(Note: do not confuse the “Paul Ehrlich” discussed above, with the modern environmentalist “Paul Ehrlich” who is best known for losing his bet with Julian Simon.)

A True Christmas Story of Hope and Justice

Gerhard Domagk. Source of photo: http://www.nndb.com/people/744/000128360/

Gerhard Domagk spent most of his adult life in a focused, tireless effort to find the first cure for a bacterial infection. Finally, his laboratory discovered a sulfa drug they called “Prontosil,” that seemed effective against strep and some other infections. Domagk published his first preliminary results on the drug in February 1935 (see Hager, p. 164). An increasing number of doctors began testing the drug on their desperate patients.
Life is not always unfair:

(p. 181) In early December 1935, just after the French published the discovery that pure sulfa was the active ingredient in Prontosil, Domagk’s six-year-old daughter, Hildegarde, suffered a bad accident. She was making a Christmas decoration in their house when she decided that she needed help threading a needle. She was on her way downstairs to find her mother, carrying the needle and thread, when she fell. The needle was driven into her hand blunt end first, breaking off against a carpal bone. She was taken to the local clinic and the needle was surgically removed, but a few days later, her hand started swelling. After the stitches were removed, her temperature rose and kept rising. An abscess formed at the surgical site. She had a wound infection. The staff at the clinic tried opening and draining the abscess. When it became reinfected, they opened it again. Then again. The infection started moving up her arm. “Her general state and the abscess worsened to such a point that we became seriously concerned,” Domagk wrote later. “More surgery was impossible.” She was falling in and out of consciousness. The surgeons were talking about amputating her arm. Once the blood tests showed that the invading germ was strep, Domagk went to his laboratory and pocketed a supply of Prontosil tablets, returned to her hospital room, put the red tablets in her mouth himself, and made certain that she swallowed. Then he waited. A day later her temperature continued to rise. He gave her more tablets. No improvement. On day (p. 182) three he gave her more, a large dose, but there was still no improvement. Her situation was growing desperate, so he pulled out all the stops, on day four giving her more Prontosil tablets, then two large injections of Prontosil soluble. Finally her temperature started to drop. He gave her more tablets. After a week of treatment, her temperature finally returned to normal. The infection had been stopped. By Christmas she was able to celebrate the holidays with her family.

Why You Want Your Surgeon to Be a Disciple of Lister

The sources of new ideas are diverse. Sometimes, as below, even a newspaper article can provide inspiration.
The passage below also provides another example of the project oriented entrepreneur, who is motivated by a mission to get the job done.

(p. 60) In Lister’s early years, the mid-1800s, half of all amputation patients died from hospital fever; in some hospitals the rate was as high as 80 percent. Lister, like all surgeons, had little idea of how to improve the situation. Then he chanced on a newspaper article that caught his interest. It described how the residents of a local town, tired of the smell of their sewage, had begun treating it by pouring into their system something called German Creosote, a by-product of coal tar. Something in the creosote stopped the smell. Lister had heard about the work of Pasteur, and he made the same mental connection the French chemist had: The stink of sewage came from putrefaction, rotting organic matter; the stink of infected wounds also came from putrefaction; whatever stopped the putrefaction of sewage might also stop the putrefaction of infected wounds. So Lister decided to try coal-tar chemicals on his patients. And he found one that worked exceptionally well: carbolic acid, a solution of what today is called phenol. . . .
. . .
(p. 61) Lister’s insistence on stopping the transfer of bacteria in the operating room became absolute. Once when a visiting knighted physician from King’s College idly poked a forefinger into a patient’s incision during one of Lister’s operations, Lister flung him bodily from the room.

Doctors Rejected Pasteur’s Work

Whether in science, or in entrepreneurship, at the initial stages of an important new idea, the majority of experts will reject the idea. So a key for the advance of science, or for innovation in the economy, is to allow scientists and entrepreneurs to accumulate sufficient resources so that they can make informed bets based on their conjectures, and on their tacit knowledge.
A few entries ago, Hager recounted how Leeuwenhoek faced initial skepticism from the experts. In the passage below, Hager recounts how Pasteur also faced initial skepticism from the experts:

(p. 44) If bacteria could rot meat, Pasteur reasoned, they could cause diseases, and he spent years proving the point. Two major problems hindered the acceptance of his work within the medical community: First, Pasteur, regardless of his ingenuity, was a brewing chemist, not a physician, so what could he possibly know about disease? And second, his work was both incomplete and imprecise. He had inferred that bacteria caused disease, but it was impossible for him to definitively prove the point. In order to prove that a type of bacterium could cause a specific disease, precisely and to the satisfaction of the scientific world, it would be necessary to isolate that one type of bacterium for study, to create a pure culture, and then test the disease-causing abilities of this pure culture.

The Benefits from the Discovery of Sulfa, the First Antibiotic

I quoted a review of The Demon Under the Microscope in an entry from October 12, 2006. I finally managed to read the book, last month.
I don’t always agree with Hager’s interpretation of events, and his policy advice, but he writes well, and he has much to say of interest about how the first anti-bacterial antibiotic, sulfa, was developed.
In the coming weeks, I’ll be highlighting a few key passages of special interest. In today’s entry, below, Hager nicely summarizes the importance of the discovery of antibiotics for his (and my) baby boom generation.

(p. 3) I am part of that great demographic bulge, the World War II “Baby Boom” generation, which was the first in history to benefit from birth from the discovery of antibiotics. The impact of this discovery is difficult to overstate. If my parents came down with an ear infection as babies, they were treated with bed rest, painkillers, and sympathy. If I came down with an ear infection as a baby, I got antibiotics. If a cold turned into bronchitis, my parents got more bed rest and anxious vigilance; I got antibiotics. People in my parents’ generation, as children, could and all too often did die from strep throats, infected cuts, scarlet fever, meningitis, pneumonia, or any number of infectious diseases. I and my classmates survived because of antibiotics. My parents as children, and their parents before them, lost friends and relatives, often at very early ages, to bacterial epidemics that swept through American cities every fall and winter, killing tens of thousands. The suddenness and inevitability of these epidemic deaths, facts of life before the 1930s, were for me historical curiosities, artifacts of another age. Antibiotics virtually eliminated them. In many cases, much-feared diseases of my grandparents’ day—erysipelas, childbed fever, cellulitis—had become so rare they were nearly extinct. I never heard the names.

Kronman Thinks It’s Good that We Die (and Charles Murray Applauds)

Over the weekend of August 16-17, 2008, I caught a few minutes of an interview on one of the C-SPAN channels. Charles Murray was handing softball questions to an academic philosopher named Kronman. Kronman was pontificating that life could only be meaningful because there was death. He suggested that those pursuing longevity research were misguided.
I sat there appalled, pondering how many wonderful, amazing projects we could get done, if only we had more time.
Some wise philosopher once said that you can only have useful dialogue with someone if the two of you have some shared assumptions. I don’t expect to be dialoguing with Anthony Kronman anytime soon. And that is just as well, since life is way too short to waste much time worrying about the Anthony Kronman’s of the world.
(In case you think I’m making this up, I quote below, from Kronman.)

(p. 229) The spiritual emptiness of our civilization has its source in the technology whose achievements we celebrate and on whose powers we all now depend.

Technology relaxes or abolishes the existing limits on our powers. There is no limit to this process itself. Indeed, every step forward is merely a provocation to go further. This might be called the (p. 230) technological “imperative.” . . .
. . .
(p. 230) If we lived forever, our powers, however great, would have no significance. How could it possibly matter whether we exercised them one way or another, sooner rather than later? This can matter to us only within the framework of a lifetime, that is, within the boundaries of a mortal existence. That we sometimes imagine (or think we imagine) that we want to have and use limitless powers in a limitless life is an illusion that always depends on our covertly smug-(p. 231)gling into our imagined picture of such an existence some essential feature of the human mortality we can never escape. In reality, the idea of immortality is for us quite unimaginable. It remains an empty abstraction.

PS: The following sentence appears on the copyright page of Kronman’s book: “The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources.”
So the longevity of books is pompously praised, while the longevity of humans is belittled?

Don’t waste time on:
Kronman, Anthony T. Education’s End: Why Our Colleges and Universities Have Given up on the Meaning of Life. New Haven, CT: Yale University Press, 2007.
(Note: ellipses added.)