Saturday, November 17, 2012

How doctors rationalize "uncomfortable" successes : natural penicillin and others

Vaccines, Salvarsan, natural penicillin
Obviously, injecting live germs into someone's bloodstream can be potentially very dangerous.

But if done right (injecting only a small number of bacteria, and using bacteria in a very weakened state) it leads to a powerful immune response.

And that prevents that person from catching the actual disease when the really large numbers of fully virulent bacteria drop by for a visit.

No mid-19th century doctor liked the thought of injecting hostile bacteria into a person's personal, private, bloodstream.

This was because the Modernist Era was also very much an aristocratic era, one that earnestly believed that one's precious genetic inheritance and the family's 'good name' was contained within the bloodstream.

However, because vaccination worked and saved lives, they had to accept it as a given but still find a way to rationalize its existence into a place in their Modernist mental universe.

They did so, I argue, by claiming the vaccine "merely" stimulated the human body's latent immune system, that marvelous marvel that God and/or Evolution had given to Man and Man alone.

All glory then to Man and precious little glory to those deadly bacteria in the vaccine.

When toxic dangerous Salvarsan came along , a compound of arsenic poison injected into straight into the bloodstream but able to cure syphilis , doctors had to accept its success.

But again, they still had to fit the idea of injecting of deadly chemicals into humans,  somewhere in their Modernist mental universe.

It wasn't too hard : the drug was totally man-made, the invention of chemistry (then the Queen of the Sciences) --- in fact, invented by German chemists when German chemists were near the top of the intellectual food chain.

Again : all glory to man !

That made Salvarsan all right, and no one asked if the Salvarsan was free of dangerous chemical byproducts or anything probing like that : it was made in a chemical factory and that was all right, then.

(They'd all seen the medical journal ads with photos of gleaming white tile walls and grave men in white labcoats standing about and no one asked if this matched the reality of real chemistry labs and real chemistry plants. Watching real drugs being made back then was rather like watching real sausages being made : not for the faint of heart.)

So in 1941, doctors received the news that Sulfa drugs were being made in instantly converted paint factories with aplomb but balked at the idea of using natural penicillin, made in hospital labs.

Now recall Paul Ehrlich's justification for using toxic Salvarsan, which by extension applies to potentially dangerous vaccines as well.

He said it had registered a positive value on his Chemo-Therapeutic Index , which measured the minimum effective dose needed for a cure, versus the maximum dose tolerated by the patient before the drug killed them as well as  - or instead of - the germ.

Penicillin is virtually unique in having no meaningful amount of toxicity ; it is practically more toxic to inject sterile water into the blood than it is to inject free acid penicillin into it.

Penicillin, the safest drug in the world, should be have been the easiest-ever medication for doctors to accept for injection purposes.

In fact it was one they opposed using - almost to a man - for 15 long, lost,  years.

Why ?

Natural penicillin's biggest problem was that it was made by lowly basement slime - and by women

Hospital labs filled with young women, with high school diplomas, handling milk bottles of  smellymold (for God's Sake !) , growing it like a crop, like down on the farm ; so rural, so old fashioned, so Victorian and so very yesterday.

Natural penicillin only became acceptable to most male doctors in early 1944, when popular magazines showed it being 'manufactured' in huge gleaming stainless steel tanks many stories high.

 'Manufactured' in factories that looked like small oil refineries, with lots of knobs, dials and grave men (men - thank God !) standing about in white lab coats.

I use scare quotes on the manufactured because behind those opaque metal walls, it was still the incredibly tiny, invisible, fungus factories that were doing the real chemical heavy lifting, not Man-the-Chemist.

Penicillin was a molecule that all the world's best chemists, working in tandem, with unlimited funds, had failed to synthesize , but the tiny weak fungus could do it in their sleep.

The fungus could do it as easy as they could make beer.

 And that is just what Jim Duhig and the fungus did in Brisbane in the Fall of 1943, making penicillin as easily as one makes homemade beer.

He then injected it straight into his patients as is, totally unprocessed any further.

 And it worked - using technology cruder than what Fleming had in 1928, 15 years earlier. It saved Duhig's patients from certain death.

It was a job so easy that Duhig said any general hospital with a lab could do it,  just using a technician.

He didn't say the lab tech would probably be a young girl with a high school diploma but you got his drift.

And you caught his contempt for his fellow Aussie scientist , Howard Florey.

Florey's 1941 paper on producing penicillin had made it seem an extremely difficult activity, somewhere between between rocket science and brain surgery, with a good doze of elaborate Heath Robinson and Rube Goldberg technology thrown in.

(Florey, who tended to put efforts to re-burnish his family's tarnished name even above aiding the war effort and above saving the lives of other doctors' dying patients, deliberately tried to scare off competitors by this method on many occasions.)

Nevertheless, those huge gleaming steel tanks made producing natural penicillin a sort of honorary chemical activity, a sort of pseudo human-synthesized drug and made a lot of Modernist doctors a lot more comfortable about using it systemically.

But after 1945 and their failure to 'make' penicillin, I think it is fair to say that modernity and chemistry started a slow sad decline into
the back pages of life....

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