The Science of Medicine

THE OPEN MIND
Host: Richard D. Heffner
Guest: Dr. Lewis Thomas
Title: “The Science of Medicine: Lewis Thomas”
VTR: 9/27/89

I’m Richard Heffner, your host on The Open Mind. And a little earlier today I heard my guest, Dr. Lewis Thomas, now Scholar-in-Residence at Cornell University Medical College and former Department Chairman, Chief of Medicine, Dean or Chancellor at five of our nation’s major medical institutions called the “Poet Laureate of the 20th Century Medical Science.”

For earlier the prestigious Albert Lasker Medical Research and Public Service Awards were announced by the Albert & Mary Lasker Foundation, and Dr. Thomas was cited for the Lasker Public Service Award for a lifetime of impressive laboratory studies joined with a delight in science that through such popular writings as his “The Lives of a Cell, “ “The Medusa and the Snail” and “The Youngest Science: Notes of a Medicine Watcher” has heightened and transformed the public’s perception of biomedical science.

As the Lasker Public Service Award citation notes “his writings have gathered new audiences for the dances of the molecules. With unfailing reverence for the complexities of biology and the pitfalls of experimentation, he has stimulated the public’s imagination to the horizons of scientific inquiry. In an age where biomedical progress depends on the public’s enthusiasm, as well as its understanding, Dr. Thomas’ writings have converted countless non-scientists into appreciative spectators and supporters of biomedical research.”

Well, now, I learned a long time ago that Lew Thomas can be counted upon always to describe the glass of life as half-full, rather than half-empty. He’d rather light a candle than curse the darkness. But a decade ago –in a paper presented at a symposium on “The Academic Physician: An Endangered Species” –mixed in with a lot of the usual Lewis Thomas optimism about the potential for human well-being, went considerable concern about the actual future of biomedical research, concern based upon his sense that our nation’s then still giant steps forward in biological science were derived largely from much earlier basic research whose pace was not being continued. As Dr. Thomas wrote, “we are dining out today on an information bank that we began accumulating just after World War II…” And I want to begin our program today by asking Dr. Thomas if now we have, indeed, adequately taken the pains he recommended then to be sure that we do constantly replenish our basic science information bank. Dr. Thomas?

Thomas: Well, we’ve done pretty well, we’ve been lucky… it has to be said. The scientific community working in what we call the biomedical sciences has run into one surprise after another, fishing up bits of information that were absolutely astonishing to everyone and it begins to look as though, if we can keep at it, we’re going to really find out some useful and important things about the mechanisms underlying human diseases that ten or fifteen years ago I would have thought were blank walls and unapproachable problems. We’re going to do well with cancer, I think, if we keep at it. We’ve got a lot of very hard problems lying ahead and we’ve got a lot more ignorance about the mechanisms of human disease than we generally acknowledge to the public at large. We really don’t know anything much about such diseases as Alzheimer’s disease or schizophrenia or rheumatoid arthritis and God knows we know far too little… still…about AIDS. Not enough, anyway, to begin making solid plans for an intelligent kind of pharmacology to kill that virus, or an intelligent kind of immunology to prepare a vaccine. Got a long way to go, but the progress that has been made in basic science has, I have to say, been astonishing.

5:00

Heffner: But you seem to indicate “astonishing” and perhaps… I won’t say fortuitous, but lucky.

Thomas: Oh, it’s always lucky. I don’t think anybody plans on this or that piece of success in basic science. Not in biology, not in physics, and not, God knows, in mathematics. What you do is ask… keep asking yourselves questions that are puzzling to you as the investigator, and for long stretches of time, you begin making guesses about what the nature of things in nature might be, and every now and then, if you’re very lucky, you get a surprise and it turns out that you’re right. But it’s a gamble.

Heffner: But. the prepared mind is the one that usually can make the most of the luck when the dice come up right, and a decade ago you were suggesting that we weren’t doing the right things to help us prepare for those strokes of luck, that we hadn’t organized the scientific community, that we were living off the fat of the land that came from the basic science we did right after World War II, and I wonder if you still feel that way?

Thomas: Yeah, I continue to worry about it. I think we should be investing, in this country, much more heavily in the support of basic biological biomedical science. I don’t know how to distinguish between these two areas of endeavor. We’re not mobilizing enough or recruiting enough… …or even interesting enough of the rising generation of our youngest and brightest people coming out of the universities. A lot of them seem to be heading for law school or business school. A lot of them are under the illusion that we know everything about everything in medicine and in biology.

Heffner: Lew, you really think that that’s one of the reasons why a lot of these young people aren’t going into your field?

Thomas: It’s one of them, yes. I think there – there are some others. The generation just ahead of them, people now in their late twenties and thirties are having their own difficulties with survival in the face of very low stipends and some instability in the grant supporting mechanism, particularly the NIH budget. All these young people know that getting support, grant support, for research is getting chancier and much more competitive. There’s a tendency now for science to be done in a different style from what it was done ten or fifteen years ago. There are big groups now and it’s possible for young people to worry about anonymity if they’re involved with twelve or fifteen or twenty other young people working on the same problem. Doesn’t seem as much fun to them as it used to, and we’ve got to do something about fixing that. I don’t – I don’t know what.

Heffner: My doctor friends tell me that that it isn’t as much fun, which seems strange to me. How have we let – how has your generation let that happen?

Thomas: About doctoring?

Heffner: I think essentially I know the doctors, so they’re talking about doctoring…

Thomas: Yes.

Heffner: …and I think that they’re talking about relations to government and relations to dollars.

Thomas: Yes. Yeah, they’re worrying about the high cost of health care. As they should be, and they’re worrying about the increasing size of the bureaucracies that are being created at state and federal and municipal levels all across the country. Having more and more to say about how medicine is practiced, and is paid for. I think that’ll get better.

Heffner: Why?

10:00

Thomas: Well, I think… I think we’re entering a period of time now… it began I suppose in the early 70’s with the discovery of the recombinant DNA technology, and then with the development of varieties of instrumentation that make it possible in the laboratory to ask and get answers to very deep problems in biology. Not yet in medicine, not yet in the pathogenesis or the mechanisms underlying human disease, but in questions about how cells work, and how we’re put together, and what governs the living systems that we all are. So much is happening that I now am far more optimistic than I used to be about the capacity that we will soon have to begin asking really smart questions about what is, indeed, going on in schizophrenia or what is, indeed, going on in rheumatoid arthritis? A lot of the money that we’re having to invest in what is called the health care system at the present time is going into diagnostic technologies. Very expensive machines of various kinds that allow us to make more and more precise diagnoses and cost a lot of money. However, when all that precision is diagnosis, we’re not able to do an awful lot more about the diseases themselves than we were some time ago, with the exception of the major infectious diseases. I go back a long time and I was brought up in a time when, when… in my years in medical school, the word “science” wasn’t much used about our craft. Why when I was a senior at Harvard Medical School, sulfanilamide turned up, and although penicillin had been around in bottles and dishes for some years, it didn’t really look like a real substance until a couple of years after I graduated from medical school, and that was an enormous change in medicine. We really could treat things, and before that, in the time when I was a medical student, and throughout most of my father’s career in medicine, there wasn’t much you could do about human disease except stand by and support the patient and the patient’s family as best you could. I mean it came into a new era with the control of infectious disease. We left behind us such big diseases as rheumatic fever, which is a rare disease now. It used to be the major cause of heart failure and heart disease and death in adolescents and young adulthood, and it’s virtually vanished because of the capacity we have for treating streptococcal infections. My neurology professorial friends tell me that it is a very rare event these days to see a patient with tertiary syphilis of the brain. What we used to call “general paralysis of the insane.” That disease occupied more beds in the state hospitals than schizophrenia and manic-depressive psychoses and all the other mental diseases combined. And it vanished. Probably because of the widespread use of penicillin. Not because of any change in our behavior, but because for the last thirty or forty years we’ve all been living with a kind of aerosol, antibiotics that are given for respiratory infections and are given inappropriately, but along the way, the latent spirochete that must have lodged itself in the same proportion of us as it did in the pre- war years, leading to tertiary syphilis got wiped out. We still see acute syphilis, more now maybe than ever before and secondary syphilis, but these are minor ailments.

Heffner: And your act of faith is that we are…

Thomas: We’re going to have something like that happen to us with the other diseases that we now can’t – get at.

15:00

Heffner: And I noticed, too, that you…you…when you talk about aging, you talk then about the diseases, you call them diseases that we too frequently associate with aging and you say, “look, these are diseases and we’re going to lick them”.

Thomas: Yeah. Doesn’t mean we’re going to live… oh, that much longer, I’m not sure there are many reasons why we should. But at least we should be able to change aging from a slow falling apart, not just of the mind, but of the body, to a reasonably healthy period of live, terminating on about the same schedule that it does now.

Heffner: You know, I, I do though want to go back to — because you’re talking about what we will do –

Thomas: Yeah.

Heffner: …and what you believe we will do, and I want to go back to your assumption a decade ago that we weren’t building for the future, as. we should, and you said, “I would go so far as to say to say that it should become a matter of national science policy for ways to be found to draw together in a single universe, the scientific resources and talents of the corporate world and of the university world.” And are you as convinced a) that that should be done, and b) that when it has been done it’s been all together salutary?

Thomas: It’s being done. It’s one of the most remarkable phenomenon that I can think of and I didn’t realize – or I don’t remember having made as much of a prediction as seems to be in that paper that you’re reading. The university world and the world of corporate science or corporate-supported science, especially the pharmaceutical industry, have remained two separate and rather hostile communities right up until the last seven or eight years, and now the situation has changed entirely, and I think it’s because of the nature of research itself. I no longer find it easy to separate, in my mind, basic science and applied science. The people in the industry now are aware in a very sophisticated way that in order to make progress in their fields, they’ve got to have close relationships with the academic world of basic science, and they’ve even got to begin setting up basic science within their own institutional walls. The relationships now between the big pharmaceutical houses and their research groups and the university groups are not only more amiable than ever before, with a lot more respect now on each – on, on both sides – they’re making progress, the thing is really working, and I wouldn’t have thought ten year ago that this was going to happen as well as it has.

Heffner: A kind of enlightened self-interest.

Thomas: Yeah. Yeah.

Heffner: Well, of course, ten years ago you did also say there were going to be those of you who would…” those of us who would disagree with you and be critical, and would say that the corporate world and the academic world,” to use your phrasing, are “up to different kinds of business with totally different, even adversarial objectives.” and I wonder about the ethics of the marketplace or the needs of the marketplace, and how they impinge or impose themselves, if they do, upon the ethics of the university?

Thomas: The only thing that worries me, and it – maybe it’s just beginning to happen now, I’m not sure of this but it’s, it’s something to worry about. Is secrecy and the withholding information from either publication or, or gossip because of constraints having to do with- patents and the development of products. That does scare me a little bit, and it could get us into trouble. So far it’s not. One of the reasons that it hasn’t is that it is – it is a fact of life that people doing good science when they encounter something surprising, and they think something is important, it is simply an irresistible urge to go out in the street and tell everybody, and these people are on the telephone long distance, telling each other everything they know, and they all acknowledge, the young ones, that that’s the only way to do science. There isn’t any such thing as a solitary scientist in an enclosed laboratory getting anywhere with his work. He’s got to gossip, and he’s got to hear what other people are thinking. That’s still going on.

20:00

Heffner: Well then, the enlightenment of the corporations involved has to be absolutely extraordinary to tolerate…

Thomas: Well, it has to be, I hope it is. I am. I have reservations about this, Dick, I’m not sure it’s going to work, but so far, knock on wood, it’s gone pretty well.

Heffner: What about patenting in the area of the life sciences?

Thomas: It’s going on all the time.

Heffner: And your response to it?

Thomas: Ahmmm, I’ve got an open mind.

Heffner: (Laughter) The returns aren’t in?

Thomas: It’s a fact of life – the returns aren’t in. But I… my judgment, in the long run is going to depend on the quality of the products that emerge from the basic science in the long run. If we get from one laboratory or another or from a collaborative venture between one of the big industries and Harvard or Cornell or the Rockefeller or some other distinguished place, a new class of drugs that will reverse the events in schizophrenia, I don’t care whether that’s patented or not. That’s going to be, on the whole, a good for humanity. The same thing is true, more urgently, for AIDS. I guess, given my preferences, I’d rather… I’d rather that patenting were not necessary. I used to find it shocking, but it’s the way the world works, and so far it seems to be working all right.

Heffner: It’s so funny… so strange, not funny. Strike that – to hear you say, “well, I used to be shocked, but now, well, that’s the way the world works.”

Thomas: Yes.

Heffner: But …what about the moral imperatives of science?

Thomas: Ah, I don’t know anything about the moral imperatives of basic science, so we’ll set that aside…

Heffner: Okay.

Thomas: It does cost a lot of money to do good basic science, and even more money to do developmental science and begin making applications. Somebody has to pay the bill for that. I would rather have that come from the industry’s own pockets than to have a governmental body providing all the money that is needed, and therefore calling all the shots from some central place in Washington. On the other hand, I can’t have everything I want. I would prefer a world in which there were no patents on things like penicillin or streptomycin or the other marvelous, much more marvelous, antibiotics, but that’s not the world I live in, and so I’m willing to make concessions.

Thomas: Well, let me ask you, we have just a couple of minutes left, and I want to ask about this world. When you were here with me on THE OPEN MIND, I think perhaps it was the last time, it was a decade ago or so, I tried desperately to get you to be leery about or critical of genetic engineering, tried to get you to see the monsters in the mess…

Thomas: Yes.

Heffner: …and you wouldn’t bite…

Thomas: That’s right.

Heffner: …you weren’t at all concerned. Your concerns heightened by this time? Lessened? The same?

Thomas: I am unconcerned.

Heffner: You really are?

Thomas: I am not worried about the things that were in the headlines ten years ago when we talked about this. I don’t think the scientists are mad men creating monstrosities that are going to be out in the streets killing us all off. On the other hand, what I asserted then and assert now is that the recombinant DNA technology is the most marvelous way to find out how cells work, and how our genes work that has ever been encountered in science, it’s terribly important, and so far as I can tell, without any hazard at all.

25:00

Heffner: You… it… “without any hazard” because there is no potential for…

Thomas: Not that I can see. I don’t think we’re going to make weapons out of this technology of any significance, not weapons that really count. I don’t believe in biological warfare – not because I don’t think it’s moral, it isn’t moral, to use biological weapons, but the main thing wrong with them is that they can’t be controlled, and they’ll bite back at anybody who tries to use them, in my view. No, I don’t think molecular biology or molecular virology, or molecular genetics are going to do anything except reveal to us more and more clearly how things work.

Heffner: Where do you think the great breakthroughs of the next decade will be?

Thomas: Oh, if I were young, I would decide to go into neurobiology. I’d – the chances of learning how the brain works over the next couple of decades, it seems to me are very bright indeed, and it’s going to be fascinating.

Heffner: Why do you pick that? Why do you pick…

Thomas: Just because of the things that have been going on in that field, and the power of the research technology for finding out about the brain, it’s an entirely different world from the one I was brought up in.

Thomas: And I’m sure knowing your optimism, you’re not concerned about the power that success in that field will give us.

Thomas: Not a bit.

Heffner: You think things will — that power will be used for the good, and never for the bad?

Thomas: I think it will be used. I think we’re going to be better off with a clearer understanding of how our central nervous systems work then we are, at our present level of profound ignorance about such matters.

Thomas: The question of mind control obviously doesn’t get into it, and we’ll have to get into that in another program though I would assume that your optimism will be the same. Dr. Lewis Thomas, thank you so much for joining me today on THE OPEN MIND. And thanks, too, to you in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program, today’s themes, today’s guest, please write to THE OPEN MIND, P. O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $2.00 in check or money order. Meanwhile, as another old friend used to say, “Good night and good luck”.

Continuing production of this series has generously been made possible by grants from: the Rosalind P. Walter Foundation; the M. Weiner Foundation of New Jersey; The Mediators and Richard and Gloria Manney; The Edyth and Dean Dowling Foundation; the Lawrence A. Wien Foundation; the New York Times Company Foundation; and, from the corporate community, Mutual of America.

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