Hepatitis B: The Hunt for a Killer Virus
Despite its title, this book is not the story of a deliberate hunt for a killer virus. It is the story of the almost accidental opening of new vistas in virology that led to a Nobel prize. It is the story of the boy from Brooklyn who became the persistent, gifted man who wandered into what he calls deep seas and blue waters -- but wandered with an open and perceptive mind. If poetry is a free-ranging, idealized representation of an idea, then this is poetry. In his book, Blumberg sets out some clues and describes some personal traits that could inspire others to go on similar wanderings. Blumberg was first interested in rheumatology, then physical biochemistry, and then inherited variations in susceptibility to disease. During the 1950s, his tool to study differences among human serum proteins was the basic immunologic agar-gel-diffusion technique. He joined the National Institutes of Health in 1957 and further tracked what he called the Ag system through Europe, the Pacific Islands, and South America. Then an unusual precipitin band present in serum from Australian aborigines was noted by his coworker Harvey Alter. The antibody to the precipitin was present in the serum of persons with poor hygiene and patients who had undergone multiple transfusions, some of whom had leukemia. The first clinical publication in 1965 named the band the Australia antigen and described it as a new marker for leukemia. Blumberg then moved to Philadelphia, marking the beginning of the hepatitis story. At the Fox Chase Cancer Center, where Blumberg remained for the next 35 years, a patient with a negative test for the antigen became positive after a mild case of hepatitis. The Australia antigen was soon recognized as a marker for hepatitis, and the hunt for what we now know as hepatitis B was nearly over. Blumberg's persistent work had revealed a new approach to understanding, preventing, and even treating viral diseases. Incidentally, it resulted in fantastic improvements in the safety of blood transfusion. Always remembering his early interest in genetics, Blumberg hypothesized that the Australia antigen traveled in populations in such a way that its controlling genes determined susceptibility to persistent infection with the hepatitis B virus. In later chapters, he expands on that theory in some musings on the human immunodeficiency virus and molecular biology that deserve to be mined by other open and observant minds. There is a chapter on the patenting of a hepatitis vaccine. Unlike the first U.S. patents, which required that working models be submitted for inspection, Blumberg's was a patent on an idea only. It was later proved by others to be an idea that worked. This book shows that it is not the orderly, directed research program that leads to the Nobel, but rather the workings of the orderly, observant mind. The neophyte can take heart from Blumberg's remarks about the system of support in the United States for young people who have ideas to pursue and who can defend their results in peer review; in this country, such young scientists are often encouraged to publish. In contrast, I can remember my surprise at seeing my first experimental work appear as a major part of a published paper with no mention of my contributions. The response of Herr Professor when he was queried was that no value would be accorded to work done by someone under the age of 25. Blumberg's book is easy to read, although it has evidently been cobbled together from writings done at different times. The author is generous in acknowledging the influence of others on his thinking and his work, but he uses the pronoun "we" to refer at times to himself alone and at other times to include his coworkers; the discriminating reader must sort out the author's meaning, which should have been done by an editor. As the author says, this book is less a scientific treatise than a human document. The scientist-reader will not find a report with the orderly format of abstract, introduction, methods, results, and discussion. The book is closer to poetry in terms of its free range, and poetry should be read regularly for relaxation, for inspiration, and for ideas.Paul J. Schmidt, M.D.Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.--This text refers to an out of print or unavailable edition of this title.