Thursday, January 24, 2013

Nobel prize merely for concentrating penicillin into a SOLID for therapeutic use ?

Gloria T Sanders (in her 1986 book on amputations of the lower limbs) mentions in passing that Howard Florey was the first to concentrate penicillin into a solid, so it could finally be used in human therapy.

This has become a commonplace in recent years, as a Google search on "Florey" and "concentrated" will quickly reveal, replacing earlier claims that he was the first to "purify" penicillin.

But since the solid penicillin was in fact not a whit more stable than Fleming's original liquid penicillin, if  both were properly stored, it offered no advantages to Fleming's wet stuff and a whole lot of disadvantages.

Florey's team had to do a great deal of expensive and labour-intensive chemical work to reduce 3 grams of watery penicillin (containing about 6 to 12 units of biological activity in total) to one milligram of solid penicillin containing about 2 to 4 units in total.

So now, instead of saving three dying patients, only one could be selected to live and the other two had to be triaged to die prematurely.

Remind me again how this was a therapeutic improvement !

And in addition, since life-saving penicillin had to be injected not swallowed, that dry milligram of penicillin had to be dissolved back into three grams of water, to put into the human body.

It seemed a long and wasteful effort, only to end up right back where you began.

The view that anything dried was inevitably better ,"more modern", than its fresh and juicy original was common in the era between the two world wars, particularly in Florey's Britain.

British cooking in the 1920s can be practically defined by the sudden availability year around of abundant and cheap dried fruits from all over the Empire.

Even today, Britain remain far and away the most avid consumers of packaged foods.

But it is not so in medicine that dry is invariably better than wet , along the road of progress.

Unlike penicillin, WWII combat blood goes from dry back to wet ...

WWII started with the military medical services of the Allies happily separating the plasma from the red cells of volunteer blood, throwing away the perfectly good and valuable red cells and then shipping the dried plasma to the combat-front to deal with fatal shock from massive wounds.

Later they realized that while the plasma did prevent immediate death from shock, a badly wounded serviceman who had lots of plasma but not enough red cells was truly over-stressing his already badly stressed heart and lungs needlessly, making survival still touch and go.

So a relatively minor administrative change (providing low tech disposable iceboxes and making liquid blood by plane transport a very top priority) allowed liquid blood to flow to the front-lines in the last year of the war - saving more lives than dry plasma could.

Concentration ,let me remind you, did not separate the tiny amounts ( ppm) of penicillin from the roughly 3% of solute solids (aka impurities) in the original gram of penicillin juice - it merely removed all the (sterile by definition) water.

But since those impurities were basically non-toxic, they were no more (and no less) harmful evaporated temporarily solid or remaining dissolved in water until they were injected.

Dignified, if alpha-male-ish, scientists do not going around saying my penis is longer than yours but they did going around saving my penicillin is purer than yours.

Which is to say, instead of concentrating penicillin purposelessly only to lose two thirds of it, they truly did purify it to a point of being between 15% to 90% pure, but at an even higher cost in terms of chemicals and labour - and penicillin - lost in the process.

But it did not save lives - it cost lives : hardly something those fine folks in Stockholm should be rewarding ....

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