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Showing posts with label insulin. Show all posts
Showing posts with label insulin. Show all posts

Tuesday, September 23, 2014

When (and why) Toronto's famed Hospital for Sick Children DIDN'T report a miracle

Miracles and Toronto's Hospital for Sick Children are mostly associated with Nobel winner Fred Banting, eleven year old Elsie Needham and insulin back in the 1920s.

Unfortunately ,they are NOT associated with July 1942, penicillin and a dying nine year old boy (possibly still alive today) known only as R. V.

Much against the will of the anglo-american medical establishment, both insulin and sulfa had their very public miracles (as in "worldwide newspaper headlines") involving saving the lives of dying children.

Banting himself pushed insulin baby miracle cures into the popular media - it seems ordinary hospital doctors in Britain did the same in the case of sulfa.

The medical research establishment didn't really fear the effect of such news headlines upon the patients and their families.

Instead, they feared its affect upon their colleagues who were not as 'measured' , 'level headed','rational' and 'scientific' as themselves.

In their minds anyway.

Because , in fact , when it comes to trying new treatments for dying patients, GPs can be faulted for being too slow off the mark, not too fast.

First the average GP trys all the conventional treatments, in a descending order of unconventionality.

Then when the patient is visibly 'decomposed' as they say in medical articles - hours from the grave  - they try sulfa or insulin or penicillin and when the patient - despite all this delay - survives and quickly goes home fully healed, it truly does seem a miracle.

Now imagine a penicillin that - by and large - doesn't work , despite the bold initial claims made for it.

The GP seeing a nearly dead patient before them , despite all the current conventional and even unconventional treatments tried upon them.

Desperate they even try this here 'pen-i-cill-in' - and it fails.

The patient dies - as seemingly they were about to anyway.

Morally,who has been harmed by all this ?

The patient and their family knows that the doctors did everything - even went the extra four miles - to try and save someone with a limited likelihood of survival.

So they failed - but at least they tried and tried hard.

No, what the medical research community chiefs fear is not failure but success.

Because then there would be big headlines celebrating drug X when drug X is still in low supply , because the drug companies are patiently waiting for the researchers' results from long term, large scale, double blind studies, before deciding whether to invest large sums in scaling up production.

Forgotten in all this long term 'research leisureliness' is that there are many real people dying needlessly and families hurting needlessly.

Because nothing speeds up mass production like the spur of real competition - and competition can come out of the woodwork whenever front page headlines scream "medical miracle -new drug - short supply".

Not every investor reads medical journals but all can translate that bit of headlinese into plain old business English : dollars, lots and lots of potential dollars, to the firm that supplies Doctor Mom first.

WWII's penicillin almost never became a miracle drug.


The first few years of penicillin miracle cures in North America deliberately went unreported in the medical media --- let alone the popular media.

In Britain, one series was published in a medical journal but the popular press was successfully avoided by its lead author, Howard Florey.

Somehow, all the British daily newspapers' science cum medical journalists normally assigned to read medical journals for potential stories were charmed into staying mum on this big headline story.

Even in wartime, Fleet Street is highly competitive - it must have been a hell of a scientific "D" notice to silence the lot of them.

The reason was that the anglo american medical research leadership was hoping to turn penicillin-the-universal-lifesaver into penicillin-the-Allies-secret-weapon-of-war.

 And - to their eternal shame - anglo american science slash medical specialist reporters matched them into forgetting their sacred professional vows.

That these medical researchers - all men - were smart there can be no doubt.

Perhaps the smartest thing they ever did was to successfully evade the front line trenches in WWI , despite being fit enough.

Now that they were all fat and all over forty, they had become positively warrior fierce.

They would help win the war by denying lifesaving penicillin to dying Allied , Neutral, Occupied and Enemy civilians - despite that oath thingy they all swore when they first became doctors .

That same ancient oath was incorporated into the requirement to give equal treatment too all the sick and wounded, under the Geneva Convention on warfare.

They would even deny giving penicillin to Allied POWs in enemy hands - and to Allied wounded judged too damaged to ever likely see combat again.

Just for a few years ,you understand - just a few years of keeping news of penicillin miracles out of the Allied popular media read by neutral officials friendly to Nazi Germany.

So it could give a big medical advantage to the Allies when casualties got really heavy after D-Day.

Canadians went along too of course - there can't be many American or British asses we won't lick , if asked politely enough.

So back to the Hospital for Sick Children and poor little R.V.

He appeared deadly ill upon arrival at the hospital from blood poisoning brought on by a (botched ?) effort to remove a mildly diseased tooth.

Sixteen days of sulfa drugs had still left the boy in dire state - never conscious , high fever, high bacterial colony blood count , etc.

His health then took a turn from very very bad to 'death is near'.

The American doctor charged with controlling the limited supplies of penicillin being made (for clinical testing), Chester Keefer in Boston, was contacted.

Perhaps a personal contact between this very well known research doctor and someone big in research in Toronto, who knows for sure ?

Keefer gets Squibb Drugs in New Jersey to send up some of the badly filtered penicillin that Squibb was famous for turning out.

After some more filtering in the Toronto hospital, the penicillin is injected into R.V. and quickly claws him back from the grave and soon sends him on his way home.

This miracle was not reported in the medical or popular media despite July 1942 being perhaps the lowest point of the war for British Commonwealth morale (the fall of the Tobruk fortress) - such a severe morale crisis that even Churchill himself thought he might be forced to resign).

A Commonwealth lad saved by British medicine might seem to be the very morale tonic needed to pick up everyone's spirits - but it was not to be.

It was finally reported in December 1943 by Dr Nelles Silverthorne in the Canadian Medical Journal, CMJ.

Or should I say Silverthorne was allowed (or encouraged) to publish a crucial four months after Dr Dante Colitti took revenge on New York's medical elite and spilled all about penicillin, babies and miracle cures to Citizen Hearst's vast media empire ---- and ultimately to the whole world.

Dante's miracle baby ultimately died but not before his apparent early success with Baby Patty Malone touched so many mothers' hearts that the mass production of penicillin-for-all was assured from that point on.

But Canada, Toronto, The Hospital for Sick Children ?

They all just blew it ....

Thursday, October 24, 2013

Penicillin is not Avastin, but it could have been...

My book - The smallest Manhattan Project  - is about us , all 10 billion of us , here today or years dead, whose lives have been improved by the advent of inexpensive penicillin.

In a sense, this book is a rarity : one written from the patient's eye view of how that drug came to be ; a welcome change after decades of endless books exclusively devoted to how penicillin looked to the people who discovered and developed it.

Penicillin is frequently called the Miracle Drug but few consider that its biggest medical miracle was really in fact its cost, or rather 'lack of cost'.

Because the diseases that penicillin treats are contagious,  patients too poor to afford a cure remains a reservoir of the most virulent strains, waiting to infect the rest of us.

There actually were methods of preventing much of these diseases before the development of penicillin : they included the ready availability of good jobs, good food, cleaner and bigger homes, greater social respect.

Baring that, only the worldwide availability of a drug that would cure those diseases once they started up, at a price that almost all could readily afford , could reduce these diseases from being endemic or epidemic to just names in a dusty medical textbook.

That is why I can say, with absolute assurance, that even those of us who have never had a single treatment of beta-lactam (penicillin family) antibiotics are in better health today because the grandparent of them all, Penicillin G , is water cheap - literally a lifesaver "too cheap to meter" .

But it almost didn't happen , we almost lost "inexpensive penicillin".

We almost got an expensively patented synthetic drug more akin to Avastin and all those other $100,000 a year plus medications.

"The smallest Manhattan Project" is the story of a doctor ( himself slowly dying of another unrelated disease) who sacrificed his own health to see penicillin from the patient's point of view.

His name should be honoured for all time.

This, despite the fact that he did not discover penicillin and then neglect it (Fleming) nor did he start its re-discovery and eventual development, albeit while pursuing a pathway that nearly killed off that development (Florey).

Dr Martin Henry Dawson, for that was his name, merely said penicillin should be made available - now! - for every single patient whose life could be saved by it , even during the height of a Total War .

Nay, he went much, much further.

Dawson in fact said all should have access to life-saving penicillin, particularly in the middle of a Total War.

That was because that war was supposedly being fought against one opponent in particular, solely because that opponent's core philosophy said that 'some lives are more worthy than others'.

How could we continue to conduct that war with any moral vigour when our own medical establishment was 'me-tooing' Hitler's doctors ?

Now the mantra 'Penicillin for all who needed it regardless of their income level or skin colour' in the mid-1940s meant its mass production, given the vast amount of infectious disease endemic in those years.

And mass production has its myriad ways of driving production costs down, down , down --- as happily happened in the case of Penicillin G in almost textbook manner.

'Penicillin for all' quickly became 'inexpensive penicillin for all' and once that happened, penicillin began to work almost like the way a good public health vaccine program should work : the treatment of the many ultimately offering 'herd protection' to all the rest of us, free of charge.

Insulin is another drug frequently called a miracle drug.

But the sad fact is that it is far more common today than it was beforeinsulin was discovered, for a variety of reasons.

By contrast, the names of all those bacterial household scourges that so terrified our mothers and grandmothers are not even known to most of us under the age of 50, and most doctors practising today have never seen a case of them.

And that is just the sort of modern day miracle that Dawson's mantra of 'penicillin for all' can produce.

For the complex truth is that our choice of medical ethics has economic consequences and these in turn feedback and have medical consequences.

The case of what the mantra of 'penicillin for all' ultimately led to should be taught in every health economics and health ethics oriented university department for just those very reasons....

Saturday, December 1, 2012

Florey vs Dawson : penicillin to be perfect & a war medicine OR an imperfect but universal medicine ?

patricia (Patty) Malone penicillin breakthrough september 1943
Baby Patty Malone helped the whole world discover penicillin 
As should be well known, penicillin-the-molecule and penicillin-the-lifesaver were discovered September 1943 by the whole world, (not in September 1928 by Alexander Fleming) while natural-penicillin-the-universal-livesaver was invented on October 16th 1940 by Henry Dawson.


Penicillin-the-molecule was ignored in June 1929, firstly by Alexander Fleming himself and secondly by the world.

This was because Fleming on that date indirectly denied any possibility of penicillin ever becoming a lifesaver, ie a systemic ( spread through the blood system) medication.

As a result, Fleming - and the world - yawned.

Contrast this with Banting team's excited, animated, passionate announcement --- at a Boxing Day medical conference just a few years earlier  -- that it was  just two weeks away from injecting insulin-the-lifesaver into a dying patient.

(What a Boxing Day present for millions of diabetics and their familes !)

You can just bet that insulin-the-lifesaver and insulin-the-molecule were discovered together, by the entire world, at that moment.

What about Howard Florey then ? Didn't he play some role in penicillin ?

Yes, some role.

But Florey ,along with Fleming, and along with the British and American governments together with the leading firms in the pharmaceutical world, was convinced that penicillin first must be perfected (100% pure, industry-made, probably synthetic, tested-onto-death) before being used on humans .

 And even then 'humans'  really meant 1A military personnel only, at least during the war.

In addition, they all only saw penicillin as an useful supplement to the existing sulfa drugs - mostly for use in sulfa-resistant staph infections.

Truly a perfectionist and limited vision of wartime penicillin.

One can only begin to imagine the high prices that would be charged governments and patients for such perfect material.

Chain deserved less credit for his chemistry and more for his pushiness , in forwarding the penicillin story to a happy conclusion...


By way of total contrast, only five weeks after learning of penicillin's lifesaving potential (and here Florey and above all Chain deserve the credit) , Dawson was injecting life-saving penicillin into 4F civilians ( Negroes ! Jews !) dying from a strep infection (SBE) , using imperfect , impure, hospital-made, natural, penicillin made by slimey molds.

Yes, like Banting's first insulin injections, Dawson's first penicillin injections 'stung like a bee', from natural impurities still in it. The stings, in both cases, did no permanent (or even temporary) harm.

To Dawson (and to Banting, his model) saving dying patients today with imperfect, impure medication was preferable to letting them die so we can maybe save dying patients, years from now, with a perfected pure medication.

These clashing visions of penicillin ran throughout the war with Florey's vision overwhelming dominant until Dawson's success with -stolen - government issue penicillin on SBE patients inspired another local doctor (Dante Colitti) to jump over the traces for his dying patient as well.

The resulting  heart-stirring story of baby Patty Malone ( late August - early September 1943) broke the media floodgates and the entire civilian world began to "ACT UP" and demand Dawson-style penicillin - now !

By 1944, the Allied governments, dragging the still reluctant Big Pharma firms along with them, had caved.

Semi-purifed, semi-perfect - CHEAP- natural penicillin was being mass produced and being made available for all, as fast as that was humanly possible.

And not just Allied civilians as well as Allied military personnel , but for Axis POWs , Neutral nation civilians and ultimately even Axis civilians.

Canadians Banting and Dawson and Canadian Medicare : there is a pattern here :  a strong belief in medical care that is universal in theory as to who is permitted to receive it (everyone, anywhere) and universal in practise (as a result of being very inexpensive).

But it wasn't something simply discovered and instantly received with acclaim by everyone - as science historians want you to believe how science works : as a totally bloodless affair.

 Instead, it was invented by some humans and contested fiercely by some other humans until finally most humans accepted it.

Invented by people like Banting, Dawson and Douglas ...