August 14, 2013 11:05:50 AM
We think of scientific advances, especially those that have a humanitarian bent like medical research, as being claimed in a harmonious effort between individuals and teams. A little conflict due to competition is accepted, but the participants do have a higher good in mind and work for the benefit of humanity. This may actually be the case for many research efforts; it was not the case in the search for the cure of polio. Let us take pride that polio is all but vanished now; it's a magnificent accomplishment. Victory, however, was not gained by idealistic heroes, but by self-interested and flawed rivals who used practices of shameful ethics and skullduggery to gain their points. "There are few gentlemen in the history of polio," writes Gareth Williams, a British doctor who besides medical texts has written about the conquest of smallpox. His Paralysed with Fear: The Story of Polio (Palgrave MacMillan) describes the messy way the job of controlling polio got done. Most doctors these days will not see a case of polio; it was a disease that defined the twentieth century, and if we let it continue further into the twenty-first, we have only human folly to blame. Williams's book shows how long the journey took, and how often it was made longer by entrenched ideas, distrust among peers, and simple bad faith. Williams has amassed many details for a fascinating and amusing history of how a laudable achievement came about despite often disgraceful behavior on the part of researchers who should have acted a little more like dispassionate searchers after truth.
There were few cases of polio before the end of the nineteenth century. The first epidemic was in France in 1885. The reason that polio came to be such a horror can only be understood by hindsight; it was a product of sanitation. Cleaner food and water and better sewage disposal have, of course, limited other diseases, but they also kept children from encountering versions of the virus that would give them immunity. It was clear from the first that episodes came from a disease that was contagious, but the cause was not clear. What was damaging the spinal cord of a child was teething or a bump on the head. Or it was the immigrants from Italy. Because the illness peaked around harvest time, blueberries and other produce were blamed. One American doctor in 1916 said he could spot kids susceptible to polio by such characteristics as facial features or gaps between their teeth, and people believed him through his successive editions of his monograph. In New York at that time, a rumor arose that cats caused the illness, and health officials went along with it, and 70,000 cats were killed. Other people blamed flies: "One hesitates to say," jokes Williams, "that flies created something of a buzz in the polio research community," but they did. So many American children were affected, said others, because they were pigging out on sugar. Indeed, in 1948 when Asheville, North Carolina, took up the anti-sugar campaign against polio promoted by a local doctor, ice cream and Coke sales crashed. The illness obligingly declined, but this was the natural end of the area's epidemic, not the result of a war on sugar.
It is easy enough to smile at this unenlightened foolishness in hindsight; after all, the illness was a terror and it isn't surprising that even researchers clutched at straws. The sad fact is, however, that a Viennese pathologist, Karl Landsteiner, demonstrated beyond doubt that polio was caused by a virus in 1908. Researchers instead competed by championing their own pet theories for the next five decades, and it is a sorry story of botched or distorted studies during the period that clouded the actual discovery of the virus. Manipulated statistics enabled one microbiologist as late as the 1950s to claim that bacteria caused the disease. Simon Flexner, a brilliant director of the Rockefeller Institute for Medical Research, reported with a fellow researcher that microscopic "globoid bodies" were somehow the cause in 1913, and his power was such that this is the way research went for two decades. Eventually, the bodies were found to be mere globs of harmless fat. Flexner also developed the erroneous idea that the infective agent entered the central nervous system via the nose and olfactory nerves. He was enormously powerful, and if you wanted to do polio research in the United States, you studied globoid bodies and the spread by the olfactory route. Flexner also proclaimed that vaccinations could never work against polio, and that a search for a vaccination was not only doomed to failure, it was irresponsible and dangerous.
Still, a couple of mavericks decided to do things differently in the 1940s. That might make them seem like the heroes that the battle against polio needed, and they did indeed overturn erroneous ideas of the past. But Jonas Salk and Albert Sabin had their own problems. Salk brought out an injectable vaccine in 1954, using a deactivated virus. He tested it on himself, his team, and family members, and then on inmates of a Home for Crippled Children near Pittsburgh, founded to support "destitute white children, crippled or deformed." When it came time to do the huge field tests of 1954, he was so sure he had everything right, he insisted that a control population for the experiment was superfluous, which would have made the trials meaningless. The vaccine worked realistically, but nothing could convince Salk it was not perfect, 100% effective and with no risk to anyone vaccinated. He never could accept that an injected vaccine had disadvantages which were not present in the oral vaccine which Sabin developed. The polio virus is spread by being swallowed and entering the gut; the live but weakened Sabin formulation promoted an intestinal immunity, a first line of defense. Sabin's vaccination was cheaper and had no needles, but he, too, thought that his was perfect and without flaw. He also was generally hated by his peers, even if they admired his achievements. "He was also the one who channeled the greatest energy into undermining his competitors and displayed the most obvious pleasure from seeing them run into misfortune." Neither Salk nor Sabin could allow that the vaccine of the other had any place in modern medicine; they seem to have hated each other.
And yet both vaccines had, and continue to have, their place. There is a tiny risk that Sabin's oral vaccine can revert back to a dangerous virus, and so the injected Salk version has come back into play. The one-two punch of both has meant that we are on the brink of eradicating polio. And we have been on the brink for some time, and it seems that we will just stay there. Williams writes, "I began this book in the spring of 2011 with the naive hope that I could end it with a pithy epitaph for polio. Now, it is depressingly clear that this will have to wait, possibly for many years to come." His book, a history full of smart and flawed men, ends up with real villains: the Taliban threatened vaccinators in Pakistan, and carried out threats by murdering them. Millions of Pakistani kids are out of reach of any polio vaccine, and will provide the virus with breeding grounds. "We can only hope," writes Williams, "that human nature will transform itself from problem to solution and find a way through the impasse." There may be reason to hope for such a transformation; the faulty human natures on display in this remarkable history did, after all, bring polio under some control. Perhaps eradication may come.