Sunday, August 8, 2010

How to tell a lie - and prosper

On February 1st 1964, the journal NATURE ran a long feature article by Dr A N Richards, a foreign member of the Royal Society, a professor emeritus in pharmacology at the University of Pennsylvania and the head of the medical section of America's all powerful science agency, the OSRD......

(Blogger ate about 1000 words right about here - I'll re-type it when my temper cools down - I have learned to print my blog posts out as PDFs right away since this 'incident' - ARRRGH !!!!!!)

 ......Fulton had been out in Central California investigating aviation medicine for the military and had wandered into a lab where a fungi researcher was working with this fungi ,without proper modern precautions, and Fulton was soon stricken onto death.

(Or he simply got it during the days he spent on a military base deep in this valley - the more likely explanation but a lot less colorful story...)

The disease was worked up by the American Military during the Cold War to use as a possible Germ Warfare weapon but in fact it was usually not fatal even if not treated.

But if it spreads from your lungs to everywhere else in your body, it was and is usually fatal.

Fulton eventually knew he was very sick from this fungus but he also knew he was also getting the best possible care one of the best medical schools in the world would naturally give to one of its most senior doctors - he wasn't excessively worried.

Nor where his doctors, until they took a routine swab from a unrelated boil he had on his abdomen to type it for sulfa treatment. Unfortunately, to their shock, it was filled with the fungus --- it seemed he was a goner and all kinds of "heroic' ( ie risky, foolhardy) medical interventions were suggested, as he seemed likely to die anyway.

Fulton had been telling his main doctors that his very best friend Howard Florey was  working with a totally new substance,  penicillin ---- produced by another fungus --- and finding it could kill an ever-widening array of microbes.

These doctors decided not to tell Fulton that his boil meant he likely faced a painful death and instead enlisted him to pull strings to get some penicillin for  a fellow patient, Anne Miller.

They secretly would divert a bit of it, to see if killed off rival fungus and so save Fulton.

This was good peacetime science - but in wartime, the medical establishment tended to say, if it isn't a common military disease, let the man die - we need the penicillin more elsewhere.

Luckily for Fulton, the military had lots of bases in this valley and military men were getting sick and dying from this fungus - so a military need could be evoked - in a stretch.

Merck, the OSRD,and the COC had all gotten pitiful pleas for penicillin before the phone calls from John Fulton---- and turned them all down.

The calls usually involved SBE, an almost always fatal form of endocarditis that - in those days - usually stricken young teens and young adults.

These kids were considered by the medical establishment as the $Fs of the $Fs, as people not worth wasting penicillin on during an all out total war.

Martin Henry Dawson had said since 1940 that he felt that penicillin could cure SBE - war or no war - and they should be saved.

No other doctor in the world believed strongly that they should - at the time.

Most still didn't feel SBEs could be cured or were a priority, even at the time of his death in 1945 - by which time he had about three dozen cures - some cured for as long as three years with a repeat bout.

Norman Heatley of Florey's Oxford University penicillin team was working for Merck and reporting everything back to Florey in England.

He had already recorded in his diary, in November 5 1941 and December 3 1941, receiving pleas to provide penicillin to individuals dying of SBE, while visiting labs in Canada, Dawson's home country.

Merck, the ORSD, the COC hadn't helped young Joan Murray with her SBE then, so why help Anne Miller now ?

(Heatley, not a medical doctor, seems to have felt in his 1942 diary that Miller might have SBE.)

Let us, for a moment, return to Richards.

The thesis of  Richards and  all the other medical bureaucrats in charge of wartime penicillin was simple - "give us lots of taxpayers' money, leave us alone away from taxpayer scruntiny, and we will produce penicillin quickly and cheaply and distribute it objectively and absolutely without favouritism."

In fact, the very first case the OSRD/COC and Merck was involved in was a blatant case of favoring the mighty and the wise over the weak and foolish.

Once it was secretly told to a very few people - perhaps only Richards - that the penicillin for Miller was also going to go to help save Fulton, it made it likely that penicillin would be forthcoming.

In his own right, Fulton was considered a valuable part of the medical brains that America felt it needed to husband if it was to win the war --- he and his own doctor, Francis Blake, were high up in the war medicine committees deciding American health priorities.

The scientists found that even the politicians, the military and the business elite (and perhaps the general public as well) agreed that healthy, fit 1A  scientists shouldn't be drafted - too valuable to the war effort.

The same thinking said penicillin was wisely used if it saved Fulton --- unwisely used if it merely went to save 4F useless SBE kids..

More importantly, Fulton was the very best friend of Florey, a man with few really close friends.

The other closest friend that Florey had in America was Richards himself.

Richards and Merck needed Florey on their side if they were to convert a largely British effort into a profitable venture for Merck in America.

While Blake secretly pulled strings for Fulton and Fulton openly pulled strings for Miller, the key person, I believe, was Richards.

The OSRD and CMR, the COC ,the NRRL,the British MRC and TRC, Merck and other drug firms , the NRC-NAS, the military Surgeons General, basically every official and semi official body connected to wartime penicillin all reveal a long paper trail of documents showing they usually bowed to Richards' dictates.

Luckily for Fulton, while the penicillin didn't do anything for his strain of fungus, careful nursing care kept him alive till his own body pulled him through.

He apparently never knew how he had been 'used' to help save his own life.

Anne Miller's case was not the first one involving penicillin in North America.

Dawson and Meyer's homebrew penicillin and Pfizer penicillin had treated at least 15 cases by March 14th 1942, the day Anne Miller got her famous first needle.

One had gotten penicillin - in fact history's very first needle of penicillin - and been cured - but not by penicillin.

Some had been cured by Dawson's penicillin - but the penicillin hadn't been injected internally as an antibiotic only dropped into an eye as an antiseptic.

A few cases of Dawson's had already been treated by the first commercial penicillin used clinically in North America - Pfizer lot number 696, first injected March 5th 1942, according to his co-worker, Gladys Hobby,in her lab records and correspondence file, as recounted in her 1985 book, PENICILLIN - MEETING THE CHALLENGE.

Because Pfizer wasn't in the OSRD-COC-Merck-Squibb agreement, its commercial penicillin wasn't counted by Richards and the OSRD when it came to proclaiming Anne Miller the first patient cured by penicillin in America.

Nor was Abbott or Eli Lilly, both huge drug companies back then, soon to do their own independent-of-the-OSRD/COC clinical trials.

But interestingly, the OSRD/COC were glad to add Dawson's cases, produced from this invisible Pfizer penicillin, to their total of the first 100 cases treated by penicillin in America.

AND Hobby says that Richards knew and personally approved Pfizer sending this commercially-produced penicillin to Dawson to use clinicallly , though Pfizer was not bound to listen to Richards at all.

A few of the most careful historians today say that Anne Miller was the first person cured by penicillin provided by the OSRD and I think this is exactly right.

But there was a vast world of penicillin activity around the globe between 1938-1945 and much of it was not directed by the OSRD or any OSRD-bodies in other countries - it was the work of individuals who like Dawson merely thought they could do something right now, not perfect or big, that might help save a few lives around them.

Ironically once those agape scientists and amateurs got to Doctor Mom, she lit the fire under Richards' ass that finally got us penicillin en masse,overnight, 15 years after it was first discovered...

addendum : I just discovered that TV  megastar Dr Gregory House did reference Fulton's rare fungus disease in one of his episodes....

No comments:

Post a Comment