Sunday, November 25, 2012

Florey & Dawson's argument over wartime penicillin : Analogue or Parable?

Sharp eyed grammar experts will quickly argue that there is no real difference between analogue and parable :  they are both forms of analogy and denote the same basic things. But even they will admit, their connotations are quite different.

When it comes to drugs like penicillin, an analogue (aka the so called "me too" drugs) are knockoffs of another drug, often one produced by nature and hence in the public domain. They differ just enough from the original to be deemed patentable : profitably patentable. All easily understood.

But penicillin as a parable - like Jesus's parables, for Christ's Sake ! - how on Earth is that possible ?

Analogue penicillin is exactly what Howard Florey, Merck, the MRC, the NAS and the OSRD all spent many years and millions of tax dollars to achieve : but they totally failed to create a synthetic analogue to natural penicillin.

Instead, all the penicillin that actually saved lives during the war was Henry Dawson's natural "parable" penicillin ---- and natural production is still the basis of all our life-saving penicillins to this day.

But I am dodging your original question : how on Earth was Dawson's penicillin a parable ?

How Dawson's 1940 war aims became the Allied war aims, by 1944

On September 9th 1940, the movement for WAR medicine had definitely won out over the movement for SOCIAL medicine in America  (and all around the world wherever nations were at war or preparing for war).

Social medicine was an effort to be as ready to find cures for the diseases that afflict the poor as to find cures for the diseases of the rich ----  even if the poor couldn't fund the research or pay much for the treatments once they were developed.

Dawson was an advocate of Social Medicine.

War Medicine was a bit of an euphemism, because it really meant a focus on drugs and treatments that would be profitable because they were oriented at the diseases of the well off.

During the war, the War medicine movement was guised as claiming we simply must downplay all work on diseases for the "useless eater" 4F poor, whose cure won't help the war effort much.

Instead, limited money and resources meant we must focus on curing the diseases and injuries of the 1A men in the military, who are needed to end the war successfully.

But Dawson felt the Allied cause would only be militarily successful when it first won the world's hearts and minds, by showing that the Allies cared for all : white and colored, rich and poor, sick and healthy.

He saw this new "war medicine" approach as an example of sinking to the level of the Axis Nazis, all in an effort to defeat them.

For Dawson, that would be a pyrrhic victory indeed !

In his own day job,(arthritis research), he saw a declining amount of upper class interest in charity to those (mostly poor) who had Rheumatic Fever and SBE and an increasing amount of attention to self-interested "self help groups" of upper class women trying to prevent diseases like polio that mostly hit people like themselves.

In terms of the war itself, Dawson who had won medals for bravery in WWI in the Canadian Army, had had to watch and listen helplessly as all-mighty America stood idle as the Nazis gobbled up one small nation after another : the Czechs, Poles, Danes, Norwegians, Dutch and Belgians.

Now Britain was expected to be invaded by the Nazi war machine that very week ---- and still America did nothing.

Dawson had been raised in a very religious family but claimed to no longer believe himself, but something in the 25 years of religious instruction still clung to him, even if only at the sub conscious level.

The wisest and the most powerful people in American Science :  the self-anointing Academy of American Science, the NAS, were strongly pro War medicine and they controlled almost all the resources.

They were seen as both wise and mighty.

Very well, Dawson would do the total reverse: he would act 'foolish' and work with the weak.

Now we do not know what Dawson felt, on the conscious level let alone on his sub conscious level, but we do see definite patterns in his actual behavior in those five early weeks of his penicillin effort - patterns inconsistent with most of his life until then.

He had never been involved in drug development before now - a process that is vastly elaborate and expensive and extends many years, over many organizations, before the drug is deemed ready to be injected.

It is a process that positively reeks of professional dignity and decorum taking its good old time, slowly grinding on and on, like the mills of the gods.

So he set out to do it as foolishly and as undignified as possible : and did up the entire job from start to finish, in less than 5 weeks !

And he did it with a very small team, (4 people in total) using tiny scraps of unused space all over the hospital : corridors, fire escapes, under seats in auditoriums ,to create a full sized pilot plant to grow and process natural penicillin.

He did not seek out the institutional money and support from drug companies and America's all powerful Foundations.

He used tiny, unpopular, penicillin producers - the smelly slime found on basement walls - and then dared to inject the result - impure and dirty - into human veins.

Even his patients were from the poor and the weak : American's 4Fs of the 4Fs : young male SBE patients.

Part of the special terror of Rheumatic Fever (RF) is that it is not a one time disease.

Even if you beat it once, it now finds it easier to come back a second and third time, because each incident leaves you more vulnerable to the next attack.

Similarly for SBE , subacute bacterial endocarditis : when Rheumatic Fever damages your heart valves, this sets them up to become the new home of normally harmless teeth bacteria ,who slowly but surely killed 96 out of every 100 patients on the first go round.

Like RF, SBE comes back time and again, as each attack leaves your valves more and more damaged and open to the bacteria's return.

So even if penicillin could cure SBE - and no one on earth but Dawson believed it could - another attack would come and require yet more hospital treatments and probably kill the weakened heart for sure this time.

No rational army general or factory owner wanted SBE youths : they were simply an expensive death sentence waiting to happen.

SBE had to be seen, most doctors felt, as the lowest priority fatal disease we have, during a total war situation : sorry, about your dead son or daughter , deal with it.

It didn't help - to be brutally frank - that RF and SBE mostly inflicted the working class ethnic minorities , far beneath the average American doctor's social standing in the 1940s : those who were about to die as a result of this decision were no one they knew.

But it was two members of this group, a Negro and a Jew in fact , that Dawson chose to be the first in the world to receive the life-saving antibiotic.

Some how, I can't help feeling that the thumb of his injecting hand was raised in a silent gesture to the NAS : up yours !

I believe that Dawson deliberately sought to rescue the least of the these , with help from the least of these, to make a point ( a parable in actions) : any Cause that would choose to save the least of these ----during a total global war --- was a Cause worth joining and worth dying for.

By early 1944 he had convinced the Allied governments.

The Allies were now making big press out of flying penicillin into neutral nations to saving dying children.

This was all to make Dawson's original point to the half of the world's nations still sitting out the so called "The Good War"/ " The Ultimate Battle between Good and Evil" .

Wartime penicillin, made by humble mold and given to the smallest and the poorest, was the best possible proof that the Allied Cause was just and humanitarian oriented and well worth joining and dying for.....

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