Monday, August 3, 2015

October 16 1940 : upending the team's protocol

To put it bluntly, twice-wounded Lieutenant Dr Martin Henry Dawson (MC with citation for bravery) was very far from being given to routinely performing bold, brave and lonely gestures.

This despite the fact that he performed some very brave actions indeed on at least a half dozen times during his shortened life.

Beside his wartime actions, those brave acts include his June 1928 sacrificing of the start of a wonderful research career at the then citadel of medical research - the Rockefeller Institute.

All to stand up for what this very junior pro tem researcher believed in scientifically, against his all powerful and very senior lab chief (and fellow Nova Scotian) Oswald Avery on the matter of the importance of bacteria transformed with DNA.

Or consider his December 1940 decision to sacrifice his own life, if need be, (against the wishes of his wife and doctors) to try and save the lives of others (the world's patients with deadly SBE) with his pioneering penicillin.

And his well known November 1942 decision to 'steal' (according to his hostile opponents) scarce government penicillin - during wartime ! - all to further his success in finally saving SBEs with penicillin, set against deliberate government 'indifference' to their dire fate - success with penicillin or not.

But my vote for his bravest, his boldest, his most lonely gesture was that which occurred on October 16th 1940.

For his solo determination to inject 'dangerously primitive' penicillin - right now ! - into a young black man and a young Jewish man in an attempt to save them from an inevitable death from SBE (subacute bacterial endocarditis) was not like his usual conflicts with higher authorities.

The people opposing his sudden decision were his own friends, down at his own level, on his own tiny team of researchers.

The protocol he was suddenly abruptly 'upending' was one he himself had helped create and agreed to adhere to.

The plan was to allocate five months (September 11th 1940 - January 11th 1941) to 'safely' purifying primitive penicillin - if not to actually totally synthesis it - before it would be clinically tested with internal - systemic - injections.

Tested upon Dawson's SBEs, if he insisted - though SBE was universally seen as the very Mount Everest of infectious disease and thus hardly a first choice for a team intent on getting those vital convincing early successes out of an untried drug.

It was always clear that Dawson wanted very much to save the lives of SBE patients.

But if he felt a drug was more likely to kill than to save - as he had earlier worried about massive doses of some new sulfa drugs - he would have been characteristically cautious rather than uncharacteristically bold.

No doctor in the world (most much bolder than Dawson), in the twelve years since penicillin was discovered, had dared to risk injecting it into the human circulation system.

This despite the fact that there were very few drugs effective against any of the deadly infectious diseases back then.

And despite the fact that in repeated internal animal testing and in repeated external testing with human blood, the primitive penicillin was very effective against the worst of the deadly bacteria cells and yet didn't harm human or animal cells, even when given in far larger doses than needed to kill the bacteria.

And despite the fact that man-made drugs with far less effect against deadly bacteria and far far worse toxicity issues had been quickly injected into test patients and brought to market.

Collective Cognitive Dissonance

With hindsight, what was going on here was a worldwide, profession-wide and prolonged case of collective cognitive dissonance.

But not all nations and not all doctors back then did any bold research into the unknown and untried --- only a few pacemaking nations and institutions led the way, for all the others to follow.

So it was actually the collective unwillingness of a small subset of the world's doctors that we must really lay blame.

Upon a few thousand upper middle class white, mostly Protestant, males from the largest medical research facilities of the most civilized nations on earth.

The Big Dogs, the Alpha Dogs, of the human medical food chain.

(Dawson's own institution, Columbia Presbyterian Medical Complex in NYC, was in the top twenty five of such institutions world wide.)

They semi-consciously simply refused to accept that possibly the world's best and safest antibacterial agent could ever come from the sort of smelly fungal slime that covered their basement walls and not from the civilized world's best clinicians and chemists.

Even when the evidence lay in the published test results before their very eyes : classic cognitive dissonance.

(Feel free to substitute negro or gypsy traveller or New Guinea 'savage' for fungal slime to better understand the popular (semi-digested) social darwinism that lay behind their attitudes.)

For fifteen years, his entire career as a medical researcher, Dawson had been proving up his point that the small, tiny, weak, simple, primitive microbes were far far smarter than we give them credit for - sometimes capable of doing things we humans are not able to do, even badly.

If penicillin was as old as the intermittent competition between soil fungus and soil bacteria over dwindling foodstuffs (at least hundreds of millions of years old) then perhaps the slime chemists had polished penicillin's abilities --- and their skill at making it --- into a fine art.

Why not 'give them a fair go' ?

The injecting only took a New York Minute - but it changed everything

So, seventy five years ago this October 16th 2015, the Age of Antibiotics finally began - and with it - our current Postmodern Age as well.

For what all the variants of postmodernity (the word 'variants' itself being a characteristic postmodern concept !) have in common is a commitment to welcoming the mixing of High and low.

Not just in Art and Architecture either --- almost all of our antibiotics today, seventy five years later, are still based upon the lowest of medicines - based upon primitive penicillin made by the slime, not synthesized by Man - the same sort that Dawson injected that day.

And when sold to doctors by the slick ad efforts of some of the world's largest and most technically advanced corporations - those antibiotics can seem to be very High medicine indeed.

But penicillin is really penicillium excrement - fungus turds.

And no matter how much High science polishes it, a turd is still a turd - even if here a lifesaving turd .

Two hundred years of a smug world of linear and hierarchical progress leading up to Civilized European Man at the very top ------ permanently upended in a New York Minute.

The lowest of the low, the slime of the slime, medical missionaries daily saving the precious children of the uncivilized world, because The Smartest Chemists In The Civilized Universe couldn't ...

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