From: des@helix.nih.gov (David E. Scheim)
Subject: Re: On pre-scientific traditions of medicine (was: Use of term allopath)
Organization: NIH
Distribution: sci
Date: Wed, 19 Aug 1992 13:59:09 GMT

>Penicillin lay unused because Fleming did not have the personality or
>resources to push its use.  

>The effective use of penicillin required a massive effort involving
>thousands of people; probably only a few governments had the resources
>at the time.  You should read the history of penicillin; Howard Florey,
>the Army, corn steep liquor, and a canteloupe from Peoria.  Penicillin
>stands with radar, Ultra, the Norden bombsight, and the atomic bomb as
>a major contributor to the Allied war effort in World War II.

There were many factors that delayed its commercial production and 
widespread clinical application, but one was the general skeptism at that 
time that any chemical compound could have sharp antibacterial effects and 
still be chemically safe -- such diseases had been intractable up through 
then.  During the thirties, some other chemical agents were discovered and 
proven effective, which lead investigators to look seriously for more such 
compounds and then back to Flemings discovery.  Some British investigators 
actually found Flemings work by performing a literature search (undoubtedly 
without the benefit of MEDLINE).

>>Various forms of therapy involving promoting an immune response and dietary
>>factors, components of which today are accepted as valid, were dismissed as
>>close to quackery for years even though careful patient records and trials
>>demonstrated success in some cases.

>This is so vague I can't evaluate it.  Could you supply some more details?

The earliest and simplist was "Coley's Toxins," which were tried late in the 
19th century by a Harvard-trained physician, William Coley.  Upon hearing of 
a case in which advanced cancer disappeared following a bout of the 
disease  "erysipelas," he tried inducing this condition in some of his 
patients using cultured germs.  He got several other such spectacular 
remissions, but the treatment method clearly had its limitations given the 
dangerous condition this disease produced (including very high fevers) and 
its contagious nature.  Today, both hyperthermia and immunotherapy are 
recognized as valid experimental approaches to cancer treatment, and "Coley'
s Toxins" were in 1975 quietly dropped from the American Cancer Society's 
list of "uproven methods" for cancer treatment, but he was scorned and 
ostracized for years.

>>Rous's claim that a germ so small it
>>passed through any filter could cause cancer was dismissed as fantasy --
>>his discovery of the Rous Sarcoma is now hailed as a breakthrough.

>Actually, viruses were well known by the discovery of RSV.  As I recall,
>the general opinion was that the RSV was not particularly important, and
>that viruses were not likely to be major causes of cancer.  Rous had to
>wait something like 60 years for recognition.

>Oddly enough, that particular conventional wisdom seems to have been
>correct (sort of).  It is now generally accepted that RSV was a sort
>of laboratory accident.  It was important in that it gave us access
>to the first oncogene, and deliberate repetitions of the circumstances
>leading to RSV gave us access to about 40 more, thus leading to the
>current ascendance of the (mostly somatic) mutation theory of cancer.

>On the other hand, the enthusiasms of the cancer virologists were fed by
>RSV and the connection between Epstein-Barr virus and Burkitt's lymphoma.
>This led to that caricature of a government research program, the
>Nixonian War on Cancer.

That was my original point -- that there have been fads of thought governing 
medical treatments, and that occassionally they influence what is accepted 
or rejected as standard treatments.

>>In cancer research, to some degree, the Watson molecular biology model of
>>carcinogenisis v. the Warburg respiration/membrane dynamic model has
>>determined what has been deemed "scientific" v. "alternative."

>I believe that the work of the last 13 years has utterly demolished the
>Warburg model.  If you know of any reliable data predicted by the Warburg
>model, and not already incorporated into the mutation model, please let
>me know.

I don't think anyone, including Warburg himself, believed that he had a well-
developed expanation for carcinogenis.  I'm referring rather to the 
underlying dynamics that he looked at.  He found in the 1920s, in the 
course of Nobel-prize winning research on cell metabolism, that tumor cells 
of all types have a much higher rate of glycolysis, even under fully 
oxygenated conditions, than their normal counterparts.  This has been borne 
out in dozens of studies since.  What I'm loosely calling a "Warburg 
respiration/membrane dynamic" model of cancer is the possibility that 
defects in respiration or membrane structure lead to weakened operation of 
the sodium pump, lowering the voltage gradiant and allowing more sodium to 
penetrate the cell.  As demonstrated in the seminal work of C. D. Cone in 
the 1960s and 1970s, this environment promotes mitosis, which in turn could 
keep the cell growing too fast to allow the metabolic or membrane 
deficencies to repair, and thus perpetuating itself.  Faster growth than the 
nuclear apparatus could properly handle promoted by such ionic conditions 
could well cause high rates of genetic mutation.

I looked at these issues about 20 years ago, and read several cases in which 
changes in the cell surface -- including simple impantation of certain 
plastics or metals on the skin -- were carcinogenic.  The fact that every 
biological phenomenum has genetic consequences does not mean that these 
consequences are primary, any more than if a seven-foot man walks into a 
doorway, causing him pain and sending out a lot of nervous signals, we 
should look at this incident as primarily involving the nervous sytem.
I offer these vague recollections and speculations with the clear disclaimer 
that we're bouncing around ideas on the net, not formulating rigorously 
documented propositions. 

By the way, I went to the University of Rochester as an undergraduate and 
also have a Math/Computer background.  -- David Scheim

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