Great Feuds in Medicine: Ten of the Liveliest Disputes Ever

Reviewed by: George Biro, MD

Disclosures

May 06, 2002

Introduction

By Hal Hellman
Wiley
Copyright 2001
256 pages
ISBN: 0-471-20833-7
$24.95 hardcover

The first thing that gets you in is the title: Great Feuds in Medicine: Ten of the Liveliest Disputes Ever. Once you open the book, you're bound to find at least one chapter to interest you.

The author, Hal Hellman, has written 27 popular science books, including a companion series: Great Feuds in Science. As we read, he comes across as being knowledgeable and concise. Hellman is readable even when discussing technical issues.

The book covers controversies from the 17th century with blood circulation theorist William Harvey to more current disputes, such as the rivalry of Robert Gallo and Luc Montagnier in the discovery of HIV. Moreover, Hellman looks beyond the obvious sources of feuds -- that research is competitive and some researchers have huge egos -- and examines, for instance, the effects of nationalism and religion. He believes that conflict is a natural sequel of discoveries.

Indeed, in his introduction, he quotes Leopold Augenbrugger, the German physician who first percussed his patients' chests. "It has always been the fate of those who have illustrated the arts and sciences by their discoveries to be beset by envy, malice, hatred, destruction and calumny" (p.ix). But as Hellman demonstrates, not all of Augenbrugger's colleagues denounced his technique; some simply ignored it for several decades.

Such neglect of discoveries has been distressingly common and more destructive than open debate. As Augenbrugger pointed out, bringing differences out into the open can hasten progress. Many a discoverer would be happy to have opponents open-minded enough to debate and test his views. Until that day comes, we will still suffer long delays: the knowledge-action gap between a scientific advance and its widespread acceptance and application.

Neglect, however, is not the problem plaguing most of the other medical landmarks highlighted in the rest of the book. Hellman notes, "When any scientist introduces a new theory, he or she is likely to be trampling on someone else's idea" (p.x). He then demonstrates how the attacks that follow sometimes disrupt the discoverers' lives. For example, antivivisectionists kept accusing Claude Bernard (1813-1878), the virtual founder of experimental physiology, of crimes against nature and society. Even his own family disowned him.

And of course, we all pity poor Ignaz Semmelweis (1818-1865, Chapter 3). He lost his job and ended his days in a mental hospital. His crime? Semmelweis argued that doctors should wash their hands before delivering babies. To be fair, though, Hellman does suggest that Semmelweis himself caused some of his own problems. Had he been less strident in attacking his opponents, might a few have accepted his message?

Among the more recent (and largely unresolved) arguments in Hellman's book are the disputes between Sigmund Freud (Chapter 7) and Carl Jung, Josef Breuer, and many others, which condemned the Austrian psychoanalyst to a life of constant pressure. While many of Hellman's chapters are now of historical interest, some issues that Freud and his colleagues debated remain unresolved and, in this reviewer's opinion, their hypotheses are untestable.

The most recent controversy covered by Hellman's book concerns the dispute when, in the 1980s, both Robert Gallo and Luc Montagnier claimed to be the first to discover HIV.* Gallo told Hellman that during his professional disputes, he at times felt like jumping into the Potomac River. His collaborator/competitor Luc Montagnier also felt the heat. He wrote: "I have seen around me jealousy, animosity, ingratitude and stupidity more than consideration and encouragement" (p.186).

Here Hellman cites nationalism as a mitigating factor in the debate: Gallo is American while Montagnier is French. More than a century before, the world saw 2 eminent fathers of microbiology (Louis Pasteur the Frenchman and Robert Koch the German) fighting as if their lives depended on it.

This dispute, and others explored in Hellman's book, demonstrates that often hidden forces, matters that have nothing to do with reason, experimentation, or evidence, fuel scientific controversies. Religion and reverence for ancient "knowledge" lay behind many of the attacks on William Harvey's work on the circulation of the blood. Dr James Primrose, a strident critic of Harvey's, wrote: "As for Aristotle, he made observations of all things and no one should dare contest his conclusions" (p.12).

Hellman also notes that simultaneous discoveries are surprisingly common; they naturally lead to bitter disputes about who "owns" the discovery. The point of such conflict is more often acclaim, perhaps the hope of a Nobel Prize, than money, and the nature of these disputes lead to their own questions. If Rosalind Franklin had not feuded with her colleague Maurice Wilkins, she may have shared the fame of discovering the double helix structure of DNA.

Or did, for example, the long, bitter, public feuding between Jonas Salk and Albert Sabin rob both men of the Nobel Prize for their work on vaccines to prevent paralytic polio (Chapter 8)? One Salk supporter complained: "He shows the world how to eliminate paralytic polio, and you'd think he had halitosis or had committed a felony" (p.141).

This book provides readers with a stimulating glimpse into medical history, both ancient and recent. Most readers will find something to enjoy in the 10 chapters.

*Indeed, at the time of publication, controversy still continues to swirl around Robert Gallo and his discovery, with new allegations coming to light in journalist John Crewdson's book Science Fictions: A Scientific Mystery, A Massive Cover-Up, and the Dark Legacy of Robert Gallo.

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