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Witnesses to Modern Biomedicine, an A–Z WITNESSES TO MODERN BIOMEDICINE, AN A–Z Edited by E M Jones and E M Tansey Volume 50 2014 ©The Trustee of the Wellcome Trust, London, 2014 First published by Queen Mary, University of London, 2014 The History of Modern Biomedicine Research Group is funded by the Wellcome Trust, which is a registered charity, no. 210183. ISBN 978 0 90223 895 4 All volumes are freely available online at www.history.qmul.ac.uk/research/modbiomed/ wellcome_witnesses/ Please cite as: Jones E M, Tansey E M. (eds) (2014) Monoclonal Antibodies to Migraine: Witnesses to Modern Biomedicine, an A–Z. Wellcome Witnesses to Contemporary Medicine, vol. 50. London: Queen Mary, University of London. CONTENTS Acknowledgements E M Tansey and E M Jones v Foreword Sir Mark Walport vii Introduction E M Tansey ix Titles of Witness Seminar volumes xvii Dramatis personae xxi Abbreviations xxxvii Monoclonal Antibodies to Migraine: Witnesses to Modern Biomedicine, an A–Z 1 Index 185 Illustration credits 215 Witness Seminars: Meetings and publications 218 iii This volume is dedicated to Dr Peter Williams CBE (1925–2014), first Director of the Wellcome Trust, 1965 to 1991. ACKNOWLEDGEMENTS Extracts from the Witness Seminar volumes have been suggested by many people in addition to the editors. In particular, we would like to thank Dr Julie Hartley, Ms Caroline Overy, Dr Tom Quick, Mrs Lois Reynolds, Mr Adam Wilkinson and Mr Alan Yabsley for their input. Additionally, Dr John Ford, Professor David Gordon, Professor Richard Himsworth and Mrs Lois Reynolds have advised and commented on the final selection. This volume would also not have been possible without the work of the former members of the History of Modern Biomedicine Group over some twenty- one years: Professor Sir Christopher Booth (co-founder, with Tilli Tansey); Dr Daphne Christie; Ms Stephania Crowther; Mrs Wendy Kutner and Ms Sonia Willhoft. For the photographic portraits, we are most grateful to the Wellcome Trust’s photographers over the years, and to the staff at Wellcome Images. We also thank the contributors who have provided additional illustrative material for our volumes. Thanks are also due to Mr Akio Morishima for the design of this volume; the indexer Ms Liza Furnival; and Mrs Sarah Beanland and Ms Fiona Plowman for proof reading. As ever, we are most grateful to the Wellcome Trust for financially supporting this programme. The first Director of the Wellcome Trust, Dr Peter Williams, was closely associated with the creation of the History of Modern Biomedicine Research Group, and attended and contributed to several early Witness Seminars. Sir Mark Walport, Director 2003 to 2013, was equally enthusiastic and often contributed directly, as his generous foreword makes clear. Finally, we thank all those who have participated in our meetings over the years, whether or not their words are included in this volume. Tilli Tansey Emma M Jones School of History, Queen Mary, University of London v FOREWORD Governments around the world obsess about how they can ensure that basic research is turned into human benefit. And governments do what governments can do, which is to provide catalysis through funding, tax breaks and a policy environment that facilitates rather than hinders innovation. But if you really want to discover how to innovate, read this volume, published in the 21st anniversary year of the first Witness Seminar on monoclonal antibodies. This is a master class on how to innovate in medicine. It is people who innovate and it is the people who scintillate in this extraordinary anthology. Their values and personalities come to the fore: humane, free-thinking, always wanting to try new things, to innovate. Their personality traits are also apparent, a cast of individualists and eccentrics, stubborn and cussedly single-minded, accompanied by a strong common denominator of caring and humane compassion. The vignette on cystic fibrosis reminded me of six months as John Batten’s SHO in the adult cystic fibrosis unit at the Brompton – an extraordinary clinician leading an equally extraordinary team. The Witness Seminar on cystic fibrosis reminds us that the substantially increased survival of people with cystic fibrosis is due to the dedication of John Batten and his counterparts around the world. The innate curiosity of clinical scientists shines through the vignettes; being both clinician scientist and naturalist is a common association, for example Cyril Clarke, Estlin Waters and Christopher Andrewes. This volume also acts as a reminder of what it means to be professional – to be scholarly and rigorous in rooting out and applying evidence, to apply judgement in clinical decision making, to be prepared to innovate, and to be responsible and accountable for decisions. I was transported in an instant to the Royal Postgraduate Medical School of my youth – and to many of the characters who passed through its doors. It also reminds us how values, ethics and innovation are intertwined. There are examples from intensive care and leukaemia and from the deliberations of the London Medical Group and from innovators in public health and population studies. I have always enjoyed the Witness Seminars – the witnesses are alive and their recollections vivid. They are always entertaining, not least because the participants sometimes disagree or have different recollections of the same events! Like all the best anthologies, this is full of gripping vignettes and stories. It should be read by all inquisitive doctors, which should give it a large circulation, since all doctors should be inquisitive. Sir Mark Walport, Government Chief Scientific Adviser, UK vii INTRODUCTION* Dr Georges Köhler, Sir Christopher Booth, Dr César Milstein (left to right) at the first Witness Seminar on Monoclonal Antibodies, 1993 In September 1993 the Wellcome Trust’s History of 20th Twentieth Century Medicine Group held its first Witness Seminar on the topic of monoclonal antibodies, for which the main witnesses, César Milstein and Georges Köhler, had shared the 1984 Nobel Prize in Physiology or Medicine. Our intention was to use the occasion to examine the events behind the headlines and accolades; to explore what did or didn’t happen; identify who were the influential players (not always synonymous with the best-known names); and to hear the voices and perspectives of a wide group of people who were ‘there at the time’ in different capacities. The success of that meeting, as assessed by the frankness of the participants on the day and their ready and enthusiastic engagement with the subsequent editorial and archival processes, compounded by several requests for copies of the edited transcript, encouraged us to develop a modest programme of four further meetings to record and reflect on recent biomedical history. Fast forward 21 years and we have now organized in excess of 60 Witness Seminars attended by more than 1400 people, and have advised several other groups and individuals on developing similar programmes. We have edited and published 58 transcripts of those meetings, most, but not all, in the freely * Page numbers refer to this volume; volume titles refer to the published Witness Seminars (see pages xvii–xx, 218–21 for full lists) ix available series now entitled ‘Wellcome Witnesses to Contemporary Medicine’. The 49th volume in that series, Migraine: Diagnosis, treatment and understanding c.1960–2010, appeared recently. Some volume titles may seem obscure, even off-putting, to the non-specialist reader. For example, The Discovery, Use and Impact of Platinum Salts as Chemotherapy Agents for Cancer and Population-based Research in South Wales: The MRC Pneumoconiosis Research Unit and the MRC Epidemiology Unit do not immediately suggest the range and depth of human interest stories they actually contain. Thus, as we approached our 50th volume we decided to collect together edited ‘highlights’ taken from all the volumes, to illustrate the diversity and richness of many individual experiences of, and contributions to, recent biomedicine. The main objective of the Witness Seminar programme has always been to hear and record the authentic voices of our contributors; for this anniversary volume we want to introduce some of those less well-known voices to fresh audiences. Selection and editing Several people listed in the acknowledgements were involved in selecting suitable extracts. Some selectors read only one or two volumes; others read rather more; and between us the two editors have read, or re-read, all the volumes. There were no restrictive criteria – all were invited to select extracts that intrigued or amused them; that seemed representative of a theme, specialty, or period; or conversely, something that was unique. Consequently, these stories and snippets vary widely – some quirky, some moving, some amusing, some thought-provoking. We have not imposed a word length – some are short and pithy, one or two are rather more expansive. Our first selection of extracts was over 500 pages long, and we have gradually refined, reduced, and edited our choices to produce a more manageable volume. For each extract, repetitions and discursive material have been removed, and sometimes sentences have been run together from adjacent paragraphs or pages to provide a continuous narrative. Dates or other explanatory material have been added where appropriate. Strictly speaking therefore, few of these extracts are verbatim quotes, and in the interests of readability we have intentionally avoided the large-scale use of ellipses, parentheses, and footnotes to identify our editorial work. For those who do want to read the unexpurgated text, each extract is carefully referenced to the original publication. Where absolutely necessary, editorial introductions have been added to a few extracts. We hope that enough introductory or editorial material has been provided to make each extract understandable, even if some of the precise technical x details may not be clear. For example, the reader does not need to know the detailed pharmacology of 5-HT to be able to grasp the significance of research programmes into anti-vomiting drugs or migraine therapies, or to appreciate the powerful stories told by the drug discoverers, the clinicians, and the patients.
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