Tuesday, December 8, 2015

wartime Penicillin : patent or parable ?

Dr Henry Dawson deliberately and uncharacteristically 'reached' well beyond his professional grasp, when during the worst weeks of WWII he resolved to employ the discounted penicillium slime to save the lives of the equally discounted SBE patients.

His direct actions over the next five years of the war saved a mere handful of lives --- and cost him his life.

But Dawson clearly hoped all along that his highly quixotic actions would be only be understandable to puzzled observers, if seen as a sort of Parable-In-Action.

As a prod to everyone's behavior during a total war against evil that was proceeding far too slowly and costing far too many lives because the Allies spent more time keeping potential helpers out of their gated community than in making room for them in a big big Big Tent.

He intended his efforts to be seen as an example of all the good things that can happen when an inclusive, rather than an excluding, process is used to solve a severe crisis, such as curing invariably fatal SBE.

Or in more promptly winning WWII itself.

I am not sure anyone who supported his direct efforts to save the unfortunate SBEs did more than dimly sense the wider 'inclusive values' vision underlying Dawson's efforts.

His vision was - by and large - his alone.

By contrast, his opponents were manifold - ultimately his biggest opponent was the very epoch (High Modernity) that the entire world was living in.

Dawson's intense interest in non-virulent/non-virile microbes (and we can included the penicillium in that mix) was seen as very old-fashioned and surprising in one so relatively young (his age was only 44 in 1940.)

For the middle-aged chemistry-minded leaders in medical science in 1940 had just overthrown (thanks largely to synthetic patented sulfa drugs and vitamins) the previous generation of medical leadership with their overwhelming interest in biological approaches (serums and vaccines) to medical problems.

To be a modern, progressive, up to date medical leader (and they all regarded Dawson as having at least a chance to become one) was to see patented chemo (therapy) rather than public domain biologics as the wave of the future.

To be modern was to just know that the primitive penicillium, simple-minded creatures that lived only to eat, poop and procreate, just couldn't possibly be smarter than the smartest human chemists in the universe - anything the bugs could do, the drug company chemists could certainly do better, faster, cheaper, easier.

Actual individual microbes have colourless skins but metaphorically, in the era of high modernity and high imperialism, their skins just had to be black, brown, red or yellow and they just had to be as dumb as white European scientists had to be smart.

Microbes' jobs, like that of darkies generally, were to step and fetch, not be leading the charge in the frontlines of scientific research.

And to be modern, fully and eugenically modern, was also to accept that not all life was equally worthy of the finest medical care - particularly not during a  total war.

The scientifically minded completely modern Germans had fully accepted this early on - it was past due time for their Allied opponents to follow suit.

Curing the long drawn-out, re-occurring, progressive, invariably fatal SBE - particularly during the scarcities of wartime - was a mis-use of medical resources - all moderns agreed to that.

Dawson rejected both arguments.

He felt the tiny penicillium factories had hundreds of millions of years to learn how to make penicillin economically and they had clearly succeeded.

Penicillium output was not just stereochemically correct and hence biologically active, it used unwanted farm wastes as feedstock and worked at one atmosphere and at room temperature (to put it in the sort of bean-counter/accountant talk that still makes synthetic chemists hot under their nylon collars).

Yes yields were a problem - but no more than whenever humanity had first domesticated any plant or animal - as always good old fashioned selective breeding would work magic.

Dawson asked how could we morally justify sending off young men to die fighting to defeat Nazis who were killing all the unfit, when we were doing the same to our unfit young men with SBE (because SBE was primarily a disease of draft age men).

Not that SBE was ever his prime focus of his metaphorical actions.

To his opponents, when he stole scarce government penicillin, it was only to waste trying save the lives of the invariably fatal SBEs, at the cost to others who needed less penicillin to survive their curable condition.

Since present day - lazy - historians still buy into this Big Lie from Dawson's wartime opponents, let us address it with facts - facts taken from the very scientific articles of his opponents.

Yes, some cases of SBE can consume enormous amounts of penicillin to affect a cure.

While the bacteria causing it were all from the same species, they vary enormously (over a vast range of one thousand to one) in their resistance to being killed by a given amount of penicillin.

But some of Dawson's SBE cases were cured with less than the amount of penicillin he devoted to the kind of diseases that his opponents thought should have higher priority - and Dawson was generally more niggardly than any other in the amounts of penicillin he injected in any case.

So Dawson actually 'stole' this government penicillin, by merely prudently re-allocating the amount of penicillin given to him, so as to reduce the dosages given to each disease.

He felt the guidelines for dosages for each disease provided by the government were far too generous (and let us note that by June 1943 he had used penicillin longer and in more serious systemic cases than had any of his opponents - including Dr Howard Florey.)

His chief American opponent, Dr Chester Keefer, was the man in charge of allocating government penicillin (much clinical penicillin in use at that point in time was not actually under government control).

Keefer was not saving patients with the government penicillin he self-allocated for himself - but rather wasting it, in large dosages, on seeing whether it cured all manner of disease, some not even of bacterial origin.

In any case, the scarcity of wartime penicillin 1939-1944 was entirely self-created by an unholy trinity of military, commercial and university-government scientists administrators ---- and Dawson knew it.

His opponents were all united in wanting to delay penicillin publicity until penicillin first emerged before the amazed public as yet another triumph of Man-Made patented chemical synthetics.

Most of his opponents also agreed synthetic penicillin should first see mass use as a military surprise weapon when the western Allies invaded Europe and began a merciless war of attrition against the Germans.

A medically superior medication that remained a chemical secret would heal the Allied lightly wounded far more quickly and effectively than the Germans could do with the existing and fast fading sulfa drugs.

This would allow the Allies to have far more manpower at the front than the Nazi war machine --- and partially make up for the Germans' recognized superiority in fighting tactics.

Yet another triumph of patented chemical synthetics, actually key to winning the battle for Europe and defeating Hitler - what a signal boost to the prospects of the chemically-minded everywhere !

(Too bad that in another corner of Dawson's university, Enrico Fermi and Leo Szilard was planning an device that would render physicists, and not chemists, as the scientists that governments, publics and the media would fawn over for the next fifty years.)

Mass production of natural penicillin actually did not need to consume scarce urban wartime resources as Dawson's opponents claimed.

Glaxo demonstrated that home truth so well in Britain and the mushroom capital of the world (Chester PA) did ditto in America.

Both used under-utilized but already existing assets found in rural areas suffering because they didn't have a nearby war-related economic activity.

Natural Penicillin used rural farm waste, rural milk-plants (there was an oversupply of them worldwide ever since the mania for clean milk in the 1920s) and cheap young untrained under-employed rural female labour.

Dawson knew this because his patient and friend famous industrialist Floyd Odlum had sacrificed his health working for the WPB trying to find useful war work for underemployed small commercial and industrial plants left without markets or access to raw materials by government fiats limiting many consumer items during the war.

Big companies and big cities, in general, got the most of the new war time contracts.

So by using existing technology and existing under-used or even idle rural industrial capacity, each Allied nation could make as much natural penicillin as their military and civilian sufferers would ever need, for the pocket costs of fielding another squadron or two of heavy bombers overseas.

Literally chump change in the overall scheme of things.

Dawson had long wanted the government to take over (in the traditional Canadian, but hardly American, way !) the production of penicillin to make enough of it for all the world's sick, where ever they were , war or not.

That was what the rules of war - the Geneva Convention - required of medicine and doctors and he won a partial victory when the combative editor of the journal SCIENCE (and the editorial board of the New York Times) took up his/the Geneva Convention's cause and won.

His parable moved at least one or two at the top of Odlum's WPB and the one power couple Dawson knew in the American drug industry.

Commercial synthetic penicillin wasn't to happen during WWII - and has never yet done so, not even so today.

But it sure looked like it would in August 1943 and so the normally ultra cautious John L Smith, prodded by his wife, was really reaching beyond his grasp when he decided to bet his small drug firm's all on the wrong horse of natural penicillin.

Say what you like about your general distaste for Pfizer, but this was their one bright shining moment, because a few very tired months later, Smith and Pfizer was producing most of the world's penicillin - more than enough for D-Day and all American civilian suffers - enough indeed for the whole wide world.

Unexpectedly Dawson's penicillin parable of hope had circled the world.

Because natural penicillin is PD and anyone can make it, it has remained cheap - our cheapest life-saver ever - and this has meant it is available to the poorest everywhere.

In being cheap and thus available to help the world's poorest, natural penicillin has had a quasi herd immunity effect for about ten billion of us since 1940, by wiping out endemic pockets of virulent bacteria among the world's traditionally untreated poor that would otherwise spread to infect even the richest upon occasion.

As more and more records are opened and more and more worried gate-keepers die off, we are learning that many noble seeming stories of WWII appear much less noble now.

But Dawson's penicillin parable is one such exception....

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