I exist
But only in you if you want me . . .
All things are meaningless accidents, works of chance
unless your marveling gaze,
as it probes, connects and orders,
makes them divine . . .
— Wilhelm Willms, “God Speaks”1
Contemplating the genesis of the great medical breakthroughs of the last
century, most people picture brilliant, well-trained scientists diligently
pursuing a predetermined goal — laboriously experimenting with first this
substance and then that substance, progressing step by step to a “Eureka!”
moment when the sought-after cure is at last found. There in the mind’s eye is
Marie Curie stirring a vat of pitchblende over many years to recover minute
amounts of radium, or Paul Ehrlich testing one arsenical compound after another
until he finds Salvarsan, the “magic bullet” against syphilis, on his 606th
attempt. In the contemporary setting, one looks to what might be called Big
Science. Surely, we imagine, in the halls of ivy-draped universities and the
gleaming labs of giant pharmaceutical companies, teams of researchers in smart
white coats are working in harmony to cure cancer, banish the common cold, or
otherwise produce the Next Big Thing in medicine.
For its own reasons, the medical establishment is happy to perpetuate these
largely false images. By tradition and protocol, it presents science as a set of
facts and strong beliefs that, like the Ten Commandments, have been set in stone
by a distant all-knowing authority and, if followed, will lead inevitably
through a linear process to the desired results. Furthermore, it portrays the
history of scientific advances as a
sequence of events that have led to more-or-less direct progress.
The reality is different. Progress has resulted only after many
false starts and despite widespread misconceptions held over long periods
of time. A large number of significant discoveries in medicine
arose, and entirely new domains of knowledge and practice were
opened up, not as a result of painstaking experimentation but rather
from chance and even outright error. This is true for many of the common
drugs and procedures that we rely on today, notably many antibiotics,
anesthetics, chemotherapy drugs, anticoagulant drugs, and
antidepressants.
Consider the following examples, all typical of how things happen
in medical research:
At the Johns Hopkins Hospital in 1947, two allergists
gave a new antihistamine, Dramamine, to a patient
suffering from hives. Some weeks later, she was
pleased to report to her doctors that the car sickness
she had suffered from all her life had disappeared.
Drs. Leslie Gay and Paul Carliner tested the drug on
other patients who suffered from travel sickness, and
all were completely freed of discomfort, provided the
drug was taken just before beginning the potentially
nauseating journey. A large-scale clinical trial involving
a troopship with more than 1,300 soldiers crossing
the rough North Atlantic for twelve days (Operation
Seasickness) decidedly proved the drug’s value in
preventing and relieving motion sickness. Dramamine
is still used today, available over the counter.
A professor of biological chemistry and medicine at
the Johns Hopkins University School of Medicine
was studying a particular blood protein when he
found another protein contaminating his sample.
Rather than simply discarding it, Dr. Peter Agre realized
that he had stumbled upon the structure of the
channel — folded-up proteins piercing cell walls —
that can control the flow of water molecules into and
out of living cells. For making this basic discovery,
which, he said, “really fell into our laps,” he won the
Nobel Prize in Chemistry in 2003.
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