Nobel laureates and their medical schools: who selected whom?

By the beginning of 2015, the United States had largely recovered from the economic crisis of 2008. The Dow had topped 18,000; unemployment was down; productivity was up. Despite this, much of the American public is uneasy about the future. Dating even before the Great Recession, poll after poll registered the belief that the outlook was bleak. When asked, “Do you think your children will grow up to be as well off or better off than you are?” the reply was usually in the negative. This was not only the case for those in the shrinking middle class and those lower on the economic ladder. The affluent, those in the top 1% or 5% of the income spectrum, were equally unenthusiastic about the future. This angst about the prospects awaiting their children has spurred efforts to obtain the best education possible to evade the glum fate threatening them. In cities such as New York, young parents, when they can afford it, seek out preschool or kindergarten programs that will give their kids a better edge in the future. Private grammar and high schools are often engaged. And then, before one knows it, high school graduation is upon them and the frantic search for the “right” college begins. For those contemplating a career in medicine, where the openings for medical school are limited, the emphasis is on obtaining a place in one of the elite colleges in the hope that this will ease the pathway into medical school. And with this, a future success in life will be achieved. Is such a belief justified? No emblem of success in medicine is greater than that of a Nobel Prize in Medicine or Physiology. For those reaching this pinnacle, is it in any way related to the colleges or graduate schools attended along the way? Between 1901 and 2014, 207 individuals received the Nobel Prize in Physiology or Medicine. Of these individuals, 95 were Americans. Among these, 17 received their formal educations abroad before settling in the United States, where the bulk of their research was performed. This leaves 78 who, in the course of their education, were confronted by college selection and later medical school selection in the United States. Details of their education and biographical facts are available online from the Nobel Foundation (1). Identification of the 10 most selective colleges was obtained from a common source, U.S. News and World Report (2). The 10 most selective of our 141 medical schools was also obtained from this source (3). Table 1 indicates the undergraduate colleges attended by the 78 Nobel laureates included in our sample. Since the total number of undergraduate institutions in the United States is over 3000, the 10 schools constitute only a fraction. Nevertheless, 18 of the 78, or 23%, attended one of these highly rated schools, attesting to their drawing power for the intellectually gifted. Still, three quarters of the group attended one of the lower-ranked colleges. Table 1. Ranked undergraduate colleges attended by 78 Nobel laureates Table 2 lists the top 10 medical schools and the numbers of Nobel laureates who attended them in the course of their education. The total tallied is 77, since one of the Nobel laureates, Gertrude B. Elion, a biochemist and pharmacologist, never obtained a doctorate degree. Here, the denominator of our calculation (“Others”), the number of medical schools in the United States, is much lower than the number of undergraduate schools applying to Table 1. However, this number has grown over the years. In 1930, there were 76 US medical schools; in 1950, 79; in 1984, 127. Currently there are 141 US medical schools in existence. Using these figures one can estimate that over the last 50 years or so, the highly ranked schools have constituted roughly between 8% (10/127) and 13% (10/76) of the total. Among the 77 individuals counted, 40 (52%) obtained their MD or PhD degrees from one of the top 10 schools. As in Table 1, this disproportionate figure reflects the desirability of these highly rated institutions. Table 2. Top-rated research schools of medicine attended by 77 Nobel laureates What is not shown in the table is that, among these 40, only 11 (28%) had attended a top 10 college prior to entering medical school. In other words, the bulk of these did not require a degree from an elite top 10 college before being accepted into that institution's graduate program. During the period studied, none of the laureates attending a top 10 school obtained both MD and PhD certification, although two attending lower-ranked schools did. This will probably change in the future, given the highly specialized work currently in progress. In the gathering of these data some interesting demographic findings regarding the Nobel laureates' birthplaces emerged. Many of them were born in the Northeast, the most densely populated section of the country. New England produced 11 laureates, but only one was from Boston. New York City claimed 17 as their birthplace. Women were underrepresented. Rosalyn Yalow, a developer of radioimmunoassays (Nobel in 1977), was the first native-born American woman to be so honored. However, over the next 27 years, only 4 more American women joined her in receiving this award. Such a disappointing finding is tempered by the fact that today the number of women in American medical schools is often equal to and, at times, greater than the number of men. Although no attempt has been made to quantify this, a reading of the 78 biographies revealed that a number of future Nobel Prize winners were often disengaged during their early school years and had only lackluster records during that time. Others began their intellectual pursuits in the humanities or other nonscientific pursuits before being directed into the field of bioscience. An associated concern about selective colleges has been addressed at some length by the provocative author Malcolm Gladwell (4). He notes that more than half of all American students who start out in science, technology, or mathematics programs drop out after the first or second year. It appears that many very bright students, when accepted into one of the top-ranked schools, become intimidated by the prodigies around them. This results in a diminishing of self-esteem and abandonment of this course of study. Gladwell argues that, had they matriculated in a second- or third-tier college, they would have succeeded in their initial goals and emerged with the credentials enabling them to function in these fields to the benefit of society, which needs more of such professionals. Although this phenomenon does not appear to apply to medical schools, given their high graduation rates, it poses an intriguing pedagogical question: When is the “best” school not the best choice? Finally, how valid is this “retrospectroscopic” approach to addressing the questions posed? Are the findings concerning this small and highly selective group applicable to the hundreds of thousands of students applying to college or medical school? Are our numbers just too small? How reliable is U.S. News and World Report? Is the awarding of a Nobel Prize the best gauge for universal success when errors of omission have been so common in the past history of the Nobel Foundation (5)? Such doubts may be justified, but the results reflected from even this small facet of investigation are compelling. We Americans like to think of ourselves as egalitarian in contrast to our British cousins. Although their educational system is organized differently from ours, it was enticing to determine the relationship of their two major universities to the awarding of the Nobel Prize. During the time period covered, 25 Nobel Prizes in Medicine or Physiology were awarded to citizens of the United Kingdom. Of those so honored, 15, or 60%, had attended either Oxford or Cambridge. This does not seem terribly different from the 52% of American Nobel laureates who attended top-tier medical schools in the United States. Perhaps we are more class conscious than we would like to think. On the other hand, tucked into Harlem, of all places, is a small cluster of incongruously designed Gothic buildings that represent the City College of New York. This once tuition-free public institution, catering mainly to the children and grandchildren of impoverished immigrants, served as an intellectual incubator for 13 Nobel Prize winners, 6 of them in Medicine or Physiology. Not a bad record for a college with no great financial endowment, no hoary traditions, and no long historical record of scholarly achievements.