The 1950s and 1960s are often hailed as the golden years of the approach to medical treatment advanced in the laboratory, insofar as one disease after another seemed to be conquered by some new vaccination or some new chemical therapeutic or another. This article will first attend to the origins of a situation where the laboratory seemed to hold all the answers to disease, and then examine developments in one particular area that has continued to develop very strongly after this heroic period, namely immunology.
The years between 1890 and 1940 were years of very rapid development for American medical research, and it quickly adopted the German approach, emphasising a close alliance of academic scientists, the pharmaceutical industry and hospitals. This alliance was greatly strengthened by the Second World War.
The British microbiologist Alexander Fleming is famous for his discovery of penicillin, but its development into the first of a new generation of powerful antibiotics is a largely American story. It was American medical researchers, well versed in the development of the products of the laboratory into industrially manufactured goods, who were able, with the aid of the Office of Scientific Research and Development, to devise processes for the production of penicillin on a very large scale and quickly develop protocols for its use on the battlefield. In the popular imagination, drugs such penicillin were just as heroic as the soldiers who fought the war.
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From magic bullets to the war on cancer
While the phrase ‘magic bullet’ usually refers to the introduction, in the 1910s, of sulphonamides such as Salavarsan, it gained a new meaning in the 1950s and 1960s, when the new alliance of academic scientists, the pharmaceutical industry and hospitals, as well as states pouring resources into the provision of medical care, seemed to answer every new challenge.
Finally defeating tuberculosis, by treating it with streptomycin, was a momentous achievement given how profoundly this disease had shaped popular culture of the 19th and early 20th century (the ‘great killer’; see Thomas Mann, The Magic Mountain, 1927: http://endeavor.med.nyu.edu/lit-med/lit-med-db/webdocs/webdescrips/mann313-des-.html). The relatively rapid development and introduction of a vaccine for poliomyelitis (polio), thanks to the work of Jonas Salk and Albert Sabin, in alliance with the National Foundation for Infantile Paralysis, however, came to symbolise the power of modern medicine to conquer all diseases.
It is important to bear in mind, however, that the new and unprecedented American public and private investment in medicine and public health was largely motivated by the desire to construct an image of the state that cared for the health and well-being of everyone in the context of the ideological confrontation between the liberal West and the communist East (Cold War).
For example, during the 1960s and 1970s, cancer became the disease that excited the energies of medical researchers, as well as private and public funding bodies, and the public imagination of this silent, spreading disease was very much informed by the politics of this ideological conflict.
Not surprisingly, in 1971, when the President of the United States, Richard Nixon signed a congressional bill that would provide massive funding ($100m) for research, it was spoken of as a literal declaration of ‘War on Cancer’. This bellicose language is fundamentally important to understanding the development of modern medical thought.
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The transformation of immunological thought
Initially, immunological thought, that is, thought about how the immune system works, motivated by desire to understand why vaccines, blood transfusions and transplants sometimes worked and sometimes not, was predicated on a fundamental distinction between self and non-self.
The body was conceived as an integrated unit, capable of recognising and reacting to external threats (from germs to viruses).
This notion of the body as a defended self has been pervasive throughout twentieth century, but it is none the less deeply problematic.
A cell, in order to react to some external substance must be able to recognise the substance, to know that the substance is present and what is the appropriate response (note that infectious reactions entail some recognition, otherwise the infecting agent could not wreak the damage it does: disease is a reaction of the body).
At the beginning of the century, Paul Ehrlich, already famous for developing Salvarsan, relied on complicated laboratory experiments, correlating their results with clinical observations, to develop the idea that the immune system worked on the basis of a lock and key principle.
The problem, however, was to explain how antibodies were formed and how they distinguished between normal and pathological situations, triggering the work of macrophages only in the latter situation.
1. These problems became particularly important to the work of blood transfusion and skin grafting. In the 1940s and 1950s, immunologists such as Frank Macfarlane Burnet and Niels Jerne suggested that antibodies were able to distinguish self from non-self, and triggered attacks only the latter, because they could not recognise and see self: the self is the effectively invisible background in which antibodies are formed when something new appears.
2. On the other hand, some clinical problems associated with the relationship between pregnant women and the developing foetus suggested that antibodies were formed even before the exposure to previously unencountered antigens (Rh+/Rh- blood antigen system).
At the beginning of the century, Ehrlich had assumed that there was an antibody for every imaginable antigen with which the body might come in contact, whether it had been exposed to it or not beforehand, but this seemed implausible to most of Ehrlich’s contemporaries and most immunologists thereafter.
3. During the 1960s, as answering these immunological problems became ever more important to clinical practice, Jerne and his followers turned to the theory of evolution by natural selection and related strategies from the world of business, to suggest that leukocytes, the cellular components responsible for the production of antibodies, continuously mutated, producing new forms of antibodies all the time, but only one copy of the antibody, which then served as the template for the production of more copies when the antibody eventually encountered a matching antigen (clonal selection: culture of flexible, ‘just in time’ production?)
4. While many immunologists have been mostly concerned with leukocytes’ production of antibodies in response to new antigens, other immunologists, especially Jerne, have suggested that, from leukocytes’ perspective, their responsibility is maintenance of the immune system (T cells, B cells and macrophages).
From this more complex perspective, the antibody does not distinguish between self and non-self. All that it cares about is the proper functioning of the immune system (‘it does its own thing’), adapting to changing circumstances by calling on its memory: our own distinction between self and non-self is absolutely meaningless to the immune system, because all that it can possibly know and act upon is an image it has produced sometime in the past, so that all that it knows is itself. Emily Martin suggests that this change in immunological thought signals a demise of the idea of a defended self.
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