- Email: [email protected]
Shedding new light on the story of penicillin
Perspectives
Book and exhibition Shedding new light on the story of penicillin I do not know about the Age of Miracles, but I think the Age of Miracle Drugs has passed. We seem to live in a time of minor modifications, add-on efficacy, and unforeseen side-effects. The Miracle Drug of my medical school days was interferon, which was supposed to cure just about anything. Chlorpromazine had just led to the community psychiatry movement, where the major psychoses were to be easily treated by a pill. The folic acid antagonists were about to lead the drive to eradicate cancer, on which Richard Nixon was shortly to declare war. We were not encouraged to think of infectious disease as a prestigious specialty to enter. It was a good time to be a medical student. These and other pharmaceutical developments still new in the 1960s were real and important. Many of the drugs we have today are even better, more powerful and efficacious. Nevertheless, we now inhabit a world of cost-benefit balancing, not miracles. Indeed, the early history of miracle drugs is principally that of quack remedies, which promised everything but delivered only profit for their vendors. Within orthodox medicine, theriac came closest to being a miracle drug: compounded of some 50 ingredients, and something of a universal remedy, it had a vigorous life from antiquity to the 18th century. In the modern period, penicillin is the exception that is supposed to prove the rule: miracle drugs do actually exist. During the late 1940s, penicillin was the drug to take. Its history is well known: Alexander Fleming’s serendipitous discovery at St Mary’s Hospital, London, in 1929; a few largely unsuccessful attempts at clinical application in the 1930s; its clinical development by Howard Florey and his team at Oxford University in the early years of World War II; the American commercial exploitation www.thelancet.com Vol 369 June 16, 2007
from 1942; its military use, spilling over to civilian populations as the war dragged on; the first postwar Nobel Prize for Fleming, Florey, and Chain. In addition, Robert Robinson won the 1947 Chemistry Nobel Prize, partly for his work on the chemistry of penicillin. Along with bis(4chlorophenyl)-1,1,1-trichloroethane (DDT), penicillin was one of the good
“In the modern period, penicillin is the exception that is supposed to prove the rule: miracle drugs do actually exist.” things to emerge from the dark years of that terrible war. The discovery and development of penicillin is an object lesson of modernity: the contrast between an alert individual (Fleming) making an isolated observation and the exploitation of the observation through teamwork and the scientific division of labour (Florey and his group). The discovery was old science, but the drug itself required new ways of doing science. This story of penicillin has been told so many times that the question might be asked, is there anything else to say? The answer, on the evidence of Robert Bud’s Penicillin: Triumph and Tragedy, is unequivocally yes. He has new and important things to say, even about the early days of penicillin work. He puts his expertise in the history of biotechnology to excellent effect, offering a rich account of the war-time development of deep fermentation plants for penicillin production in China, Czechoslovakia, the Netherlands, Italy, and France. Everyone, it seems, wanted the new drug and were prepared to devote scarce resources to its production. He is also good on the agencies, both governmental and philanthropic, that sought to offer aid and expertise to facilitate this initiative. Bud shrewdly
dissects the mixed humanitarian and commercial motives that infused the aid packages and exchanges of personnel and materials. Along the way, he dispels the myth that the British entirely surrendered the commercial potential of penicillin to the Americans. By 1945, the USA was the largest, but by no means the exclusive, producer of penicillin in commercial quantities. Several British pharmaceutical companies were also doing well with the drug. Bud’s story does not stop with the triumphal availability of penicillin in the early postwar years. He continues into the era of the semisynthetic penicillins, the development of their broad-spectrum derivatives, the issue of prescription-only versus overthe-counter purchase, the misuse for common colds and uncompleted courses, and the emergence of bacterial resistance. The latter has a much longer history than is commonly appreciated: it was recognised as a real factor, and a potentially serious problem, as early as the late 1940s, both with Streptococcus pneumoniae and our own preoccupation, meticillin-resistant Staphylococcus aureus (MRSA). Bud shows how the serious phenomenon of antibioticresistant bacteria has been integrated into a new medical field, that of emerging diseases, and invites us to contemplate a world in which antibiotics have lost their miraculous healing powers. He has too high an opinion of the late Susan Sontag’s illconceived Aids and its Metaphors but evaluates the important contributions of Joshua Lederberg and Steven Morse at New York’s Rockefeller University in putting emerging diseases on the scientific map. In dealing with the recent history of antibiotic resistance, Bud inevitably has to confront the role of the media. To his credit, he writes analytically
Penicillin: Triumph and Tragedy Robert Bud. Oxford University Press, 2007. Pp 340. £30.00. ISBN 0-19-925406-0.
Penicillin: A Story of Triumph and Tragedy An exhibition at the Science Museum, London, UK, showing until Sept 1, 2007. See http://www.sciencemuseum. org.uk/visitmuseum/galleries/ penicillin.aspx
1991
Perspectives
about emotive subjects such as MRSA, never underestimating the seriousness of the phenomenon, but refusing to pander to the hysteria of tabloid newspaper journalists and doomsday soothsayers. The same measured tone marks his sensitive chapter on the use of antibiotics in animal husbandry. The practice originated soon after commercial penicillin was available. As a 1952 headline put it: “Here is good news for both farmers and meat eaters. Antibiotics provide more meat with less feed.” A godsend, this “more for less”, since consumers wanted more, but cheaper meat. The way to meet the demand was, of course, intensive farming methods, with the results that are all too familiar.
Routine antibiotics for farm animals has always been a politically loaded issue, with divided scientific opinion leaving plenty of room for manoeuvre. As Bud shows, in the UK, one sets up a committee, which writes a report. In this instance, the Swann Committee of the late 1960s spawned another committee to advise the Veterinary Products Committee. Although Swann had recommended the abolition of antibiotics as growth promoters, guidelines were easier to produce than regulations to enforce. In the USA, advocacy groups or individuals often do the job of committees, raising public awareness and (sometimes) influencing legislators. The area is still unsettled, despite repeated outbreaks of antibiotic-resistant salmonella.
Bud’s volume offers much food for thought. His research has been massive, in the scientific and medical literature, archives, interviews, and the artefacts of penicillin research and production. The illustrations in this volume are well chosen and add materially to his text. Several of them appear in an accompanying exhibition he has produced at the London’s Science Museum, where he is head of information and research. In fewer than a dozen attractive panels, he has reproduced the message of this book for a wider audience. If you don’t have time to read the book, see the exhibition. Better still, do both.
Bill Bynum [email protected]
In brief Film In defence of liberty
Taking Liberties Since 1997 Revolver Entertainment and S2S Productions, 2007. Produced and directed by Chris Atkins. On general release in the UK. See http://www.noliberties.com.
1992
Many people in the UK might be shocked to know that since 1997 the UK Government has established 3000 new criminal offences. Rather disturbingly, many of these offences are not so much crimes as an infringement of people’s civil liberties. As shown by film-maker Chris Atkins, in his new documentary Taking Liberties Since 1997, six central pillars of liberty have been systematically eroded under New Labour during the past 10 years: the right to protest, the right to freedom of speech, the right to privacy, the right not to be detained without charge, being innocent until proven guilty, and prohibition from torture. The film tells harrowing tales of many ordinary law-abiding citizens whose lives have been turned upside down by injustice. Maya Evans and Milan Rai, for example, describe how they were repeatedly arrested under the Serious Organised Crime and Police Act for reading the names of dead Iraqi civilians at the Cenotaph in Whitehall. Other
individuals that Atkins features include Mouloud Sihali, acquitted in the so-called “Ricin plot” case and yet still under house arrest today, Moazzam Begg who was tortured in Bagram and Guantanamo without charge for 3 years, and 82-year-old peace campaigner Walter Wolfgang who was arrested as a terrorist for shouting “Nonsense!” at the 2005 Labour Party conference. Atkins makes the point that after the events of 9/11 the climate of fear and paranoia has driven the government to over-react to the terror threat. In the past 10 years, there has been an unprecedented shift of power away from the individual towards the state. Using previously unseen footage, interviews, and archive clips of relevant historical events—the suffragette movement, the rise of Hitler, the 1990s poll tax riots—alongside references to the signing of the Magna Carta and the European Convention on Human Rights, Atkins skilfully puts recent events into perspective. The pace
of the film is further assisted by fantastic animation sequences and thought-provoking quotes from such figures as Thomas Jefferson and Benjamin Franklin. Remarkably, the film manages to remain apolitical throughout as Atkins cleverly interweaves comment from across the political spectrum encompassing celebrities, human rights organisations, academics, and lawyers. Taking Liberties is that very rare thing: it made me laugh whilst making me incensed by the issues it exposes. Atkins should be commended for the irreverent boldness of his documentary. With Tony Blair coming to the end of his 10-year reign this film is very timely. Under a new leadership the government should take the opportunity to rediscover the importance of human rights and civil liberties in a modern democratic society.
Pam Das [email protected]
www.thelancet.com Vol 369 June 16, 2007
Book and exhibition Shedding new light on the story of penicillin I do not know about the Age of Miracles, but I think the Age of Miracle Drugs has passed. We seem to live in a time of minor modifications, add-on efficacy, and unforeseen side-effects. The Miracle Drug of my medical school days was interferon, which was supposed to cure just about anything. Chlorpromazine had just led to the community psychiatry movement, where the major psychoses were to be easily treated by a pill. The folic acid antagonists were about to lead the drive to eradicate cancer, on which Richard Nixon was shortly to declare war. We were not encouraged to think of infectious disease as a prestigious specialty to enter. It was a good time to be a medical student. These and other pharmaceutical developments still new in the 1960s were real and important. Many of the drugs we have today are even better, more powerful and efficacious. Nevertheless, we now inhabit a world of cost-benefit balancing, not miracles. Indeed, the early history of miracle drugs is principally that of quack remedies, which promised everything but delivered only profit for their vendors. Within orthodox medicine, theriac came closest to being a miracle drug: compounded of some 50 ingredients, and something of a universal remedy, it had a vigorous life from antiquity to the 18th century. In the modern period, penicillin is the exception that is supposed to prove the rule: miracle drugs do actually exist. During the late 1940s, penicillin was the drug to take. Its history is well known: Alexander Fleming’s serendipitous discovery at St Mary’s Hospital, London, in 1929; a few largely unsuccessful attempts at clinical application in the 1930s; its clinical development by Howard Florey and his team at Oxford University in the early years of World War II; the American commercial exploitation www.thelancet.com Vol 369 June 16, 2007
from 1942; its military use, spilling over to civilian populations as the war dragged on; the first postwar Nobel Prize for Fleming, Florey, and Chain. In addition, Robert Robinson won the 1947 Chemistry Nobel Prize, partly for his work on the chemistry of penicillin. Along with bis(4chlorophenyl)-1,1,1-trichloroethane (DDT), penicillin was one of the good
“In the modern period, penicillin is the exception that is supposed to prove the rule: miracle drugs do actually exist.” things to emerge from the dark years of that terrible war. The discovery and development of penicillin is an object lesson of modernity: the contrast between an alert individual (Fleming) making an isolated observation and the exploitation of the observation through teamwork and the scientific division of labour (Florey and his group). The discovery was old science, but the drug itself required new ways of doing science. This story of penicillin has been told so many times that the question might be asked, is there anything else to say? The answer, on the evidence of Robert Bud’s Penicillin: Triumph and Tragedy, is unequivocally yes. He has new and important things to say, even about the early days of penicillin work. He puts his expertise in the history of biotechnology to excellent effect, offering a rich account of the war-time development of deep fermentation plants for penicillin production in China, Czechoslovakia, the Netherlands, Italy, and France. Everyone, it seems, wanted the new drug and were prepared to devote scarce resources to its production. He is also good on the agencies, both governmental and philanthropic, that sought to offer aid and expertise to facilitate this initiative. Bud shrewdly
dissects the mixed humanitarian and commercial motives that infused the aid packages and exchanges of personnel and materials. Along the way, he dispels the myth that the British entirely surrendered the commercial potential of penicillin to the Americans. By 1945, the USA was the largest, but by no means the exclusive, producer of penicillin in commercial quantities. Several British pharmaceutical companies were also doing well with the drug. Bud’s story does not stop with the triumphal availability of penicillin in the early postwar years. He continues into the era of the semisynthetic penicillins, the development of their broad-spectrum derivatives, the issue of prescription-only versus overthe-counter purchase, the misuse for common colds and uncompleted courses, and the emergence of bacterial resistance. The latter has a much longer history than is commonly appreciated: it was recognised as a real factor, and a potentially serious problem, as early as the late 1940s, both with Streptococcus pneumoniae and our own preoccupation, meticillin-resistant Staphylococcus aureus (MRSA). Bud shows how the serious phenomenon of antibioticresistant bacteria has been integrated into a new medical field, that of emerging diseases, and invites us to contemplate a world in which antibiotics have lost their miraculous healing powers. He has too high an opinion of the late Susan Sontag’s illconceived Aids and its Metaphors but evaluates the important contributions of Joshua Lederberg and Steven Morse at New York’s Rockefeller University in putting emerging diseases on the scientific map. In dealing with the recent history of antibiotic resistance, Bud inevitably has to confront the role of the media. To his credit, he writes analytically
Penicillin: Triumph and Tragedy Robert Bud. Oxford University Press, 2007. Pp 340. £30.00. ISBN 0-19-925406-0.
Penicillin: A Story of Triumph and Tragedy An exhibition at the Science Museum, London, UK, showing until Sept 1, 2007. See http://www.sciencemuseum. org.uk/visitmuseum/galleries/ penicillin.aspx
1991
Perspectives
about emotive subjects such as MRSA, never underestimating the seriousness of the phenomenon, but refusing to pander to the hysteria of tabloid newspaper journalists and doomsday soothsayers. The same measured tone marks his sensitive chapter on the use of antibiotics in animal husbandry. The practice originated soon after commercial penicillin was available. As a 1952 headline put it: “Here is good news for both farmers and meat eaters. Antibiotics provide more meat with less feed.” A godsend, this “more for less”, since consumers wanted more, but cheaper meat. The way to meet the demand was, of course, intensive farming methods, with the results that are all too familiar.
Routine antibiotics for farm animals has always been a politically loaded issue, with divided scientific opinion leaving plenty of room for manoeuvre. As Bud shows, in the UK, one sets up a committee, which writes a report. In this instance, the Swann Committee of the late 1960s spawned another committee to advise the Veterinary Products Committee. Although Swann had recommended the abolition of antibiotics as growth promoters, guidelines were easier to produce than regulations to enforce. In the USA, advocacy groups or individuals often do the job of committees, raising public awareness and (sometimes) influencing legislators. The area is still unsettled, despite repeated outbreaks of antibiotic-resistant salmonella.
Bud’s volume offers much food for thought. His research has been massive, in the scientific and medical literature, archives, interviews, and the artefacts of penicillin research and production. The illustrations in this volume are well chosen and add materially to his text. Several of them appear in an accompanying exhibition he has produced at the London’s Science Museum, where he is head of information and research. In fewer than a dozen attractive panels, he has reproduced the message of this book for a wider audience. If you don’t have time to read the book, see the exhibition. Better still, do both.
Bill Bynum [email protected]
In brief Film In defence of liberty
Taking Liberties Since 1997 Revolver Entertainment and S2S Productions, 2007. Produced and directed by Chris Atkins. On general release in the UK. See http://www.noliberties.com.
1992
Many people in the UK might be shocked to know that since 1997 the UK Government has established 3000 new criminal offences. Rather disturbingly, many of these offences are not so much crimes as an infringement of people’s civil liberties. As shown by film-maker Chris Atkins, in his new documentary Taking Liberties Since 1997, six central pillars of liberty have been systematically eroded under New Labour during the past 10 years: the right to protest, the right to freedom of speech, the right to privacy, the right not to be detained without charge, being innocent until proven guilty, and prohibition from torture. The film tells harrowing tales of many ordinary law-abiding citizens whose lives have been turned upside down by injustice. Maya Evans and Milan Rai, for example, describe how they were repeatedly arrested under the Serious Organised Crime and Police Act for reading the names of dead Iraqi civilians at the Cenotaph in Whitehall. Other
individuals that Atkins features include Mouloud Sihali, acquitted in the so-called “Ricin plot” case and yet still under house arrest today, Moazzam Begg who was tortured in Bagram and Guantanamo without charge for 3 years, and 82-year-old peace campaigner Walter Wolfgang who was arrested as a terrorist for shouting “Nonsense!” at the 2005 Labour Party conference. Atkins makes the point that after the events of 9/11 the climate of fear and paranoia has driven the government to over-react to the terror threat. In the past 10 years, there has been an unprecedented shift of power away from the individual towards the state. Using previously unseen footage, interviews, and archive clips of relevant historical events—the suffragette movement, the rise of Hitler, the 1990s poll tax riots—alongside references to the signing of the Magna Carta and the European Convention on Human Rights, Atkins skilfully puts recent events into perspective. The pace
of the film is further assisted by fantastic animation sequences and thought-provoking quotes from such figures as Thomas Jefferson and Benjamin Franklin. Remarkably, the film manages to remain apolitical throughout as Atkins cleverly interweaves comment from across the political spectrum encompassing celebrities, human rights organisations, academics, and lawyers. Taking Liberties is that very rare thing: it made me laugh whilst making me incensed by the issues it exposes. Atkins should be commended for the irreverent boldness of his documentary. With Tony Blair coming to the end of his 10-year reign this film is very timely. Under a new leadership the government should take the opportunity to rediscover the importance of human rights and civil liberties in a modern democratic society.
Pam Das [email protected]
www.thelancet.com Vol 369 June 16, 2007