Beni Leshem | Dr. Beni Leshem is an immunologist and director of the Medical Research Administration in the Office of the Chief Scientist at the Ministry of Health.
Haaretz/Books, 05.3.16 | Great Feuds in Medicine by Hal Hellman, Hebrew translation by Emanuel Lottem, Sifriat Maariv, 2004, 259 pages.
A popular joke among doctors tells of a long queue of people waiting at the gates of heaven, when suddenly a figure in a white coat, with a stethoscope dangling from the pocket, appears from the side and cuts in front of everyone in line. When one of them protests, another replies: "It's all right, that's God. He thinks he's a doctor."
The book before us, which deals with ten of the great feuds in the world of medicine and medical research, brings doctors down from this godlike level and presents them as human beings, with their troubles and urges, and with their scientific path full of clashes with rivals and colleagues, sometimes to the point of personal rivalry.
The author weighed his options and, out of the many possibilities, chose ten stories that show the emotional price involved in promoting ideas that open new horizons of research. With some of them, this was my second encounter: as a child I read about Semmelweis and Pasteur in Paul de Kruif's book "Microbe Hunters", and about Sabin and Salk in the daily press. I came across others later, out of interest (Freud), during my studies as a student (Franklin and Wilkins), and as a researcher, it fell to me to know Bob Gallo personally.
The stories are translated well and accurately, and they are presented in a fascinating way, with a sound account of their historical, social and scientific background. The researchers who are the heroes of the stories are presented without the halo of research, as real human beings, with their personal problems and urges, their jealousies, which do not always show much wisdom, their hunger for publicity and their desire to be first, as well as their national pride.
All of this sheds light on the human side of doctors, the side that hesitates and can make mistakes, and perhaps undermines the common image of doctors as all-powerful figures in whose hands we place our health and our lives. In my eyes, it is precisely this humanity that raises the value of doctors, and paradoxically it gives me greater confidence as a patient, because I feel that a doctor with these qualities will know how to treat me as a person and not as a collection of symptoms.
Alongside the fascinating personal stories, the broad and continuing story of medical research is revealed: from Harvey, who discovered the circulation of the blood in the 17th century, to the story, from twenty years ago, of Gallo and Montagnier, who discovered the AIDS virus. It is astonishing to think that until 150 years ago no doctor would have thought of washing his hands after treating a patient, let alone disinfecting them before treating another patient.
The book strengthens the understanding that advanced medicine cannot exist without medical research, and that it is research that has raised medicine to its high level today and will carry it forward to the medicine of tomorrow. Governments in developed countries have recognized the enormous importance of medical research in advancing medicine for the benefit of their citizens, as well as an important and central lever for economic growth, and they invest huge sums in this field. If only decision makers in Israel would adopt this approach.
Competition between researchers is at the heart of most of the stories, and it has two faces. Competition can be destructive, as described in the story of the discovery of the structure of DNA, over which Rosalind Franklin, Maurice Wilkins, Francis Crick and James Watson quarreled (Watson's book "The Double Helix" has also been called "How to Steal the Nobel Prize"). Who knows to whom the Nobel Prize for this discovery would have been awarded if relations between Wilkins and Franklin had been better.
It is easy to imagine how much medical research could have advanced if researchers had known how, and been able, to cooperate, to share the knowledge they had gathered with others, and to create a synergy from which everyone would benefit. At the same time, the author wonders, and we wonder with him, whether research would really have reached its results today without these arguments and clashes, as in the case of Pasteur, whom the criticism he received only spurred on in his research, or the bitter clash between Salk and Sabin over the development of the polio vaccine. Scientific progress can be driven precisely by differences of opinion, by the presentation of different theories and by different interpretations of similar findings. Different approaches can correct errors and mistaken interpretations, and sometimes the way findings complement each other and interpretations are combined leads to research breakthroughs. Competition in research stimulates, motivates and pushes researchers to considerable achievements, but the enormous pressure to keep up with it has led some researchers to fabricate findings and publish them in respected scientific journals. Hellman finds traces of this too in some of the "corners" Pasteur cut in his research.
Medical research has changed the face of medicine: instead of trial and error, doctors increasingly rely on laboratory findings, and the term used today is evidence-based medicine. One of the pioneers of experimental medicine, who according to the author is considered to have helped turn medicine from an art into a science, was Claude Bernard (in the 19th century). He was among the first to draw far-reaching medical conclusions from experiments he carried out on animals. Bernard recognized the suffering caused to the animals, but saw the experiments as a necessary evil for advancing medicine and saving human lives. Even then, movements arose that spread accusations that researchers "take pleasure in causing torment to helpless animals".
It is important to emphasize that medical researchers, past and present, are very far from the cruel image of "brain grinders" that extremists among the members of movements against animal experiments still try to give them today. Moreover, today all animal experiments are carried out under strict control and supervision, while ensuring maximum animal welfare and minimizing pain and suffering as much as possible. It is clear to everyone how far behind medicine would be today without the contribution of medical research, which has needed animal experiments.
Despite the enormous progress in medicine, its scientific side still does not have all the answers. Medicine is still partly an art, and much more about it is hidden than revealed. The human factor, judgment and the accumulated experience of doctors largely make up for what is missing in scientific knowledge.
A doctor's greatness can be seen in the ability to combine the scientific knowledge gained through study and research with accumulated experience in treating patients, and to add to these that abstract and elusive factor called "intuition".
For this must be remembered: despite the enormous progress of medicine, its abilities are still limited, and all of us, doctors, researchers, patients and their families alike, still stand helpless in situations for which medicine has no adequate answer. Let us hope that the knowledge gained in the future through medical research will fill these gaps and make it possible to cure most diseases. Until then we will have to make do with what we have, and remember the words of Ben-Gurion: "Whoever does not believe in miracles is not a realist."