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Fighting the Invisible: the Struggle to Eliminate Viral Hepatitis

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Fighting the Invisible: the Struggle to Eliminate Viral Hepatitis Fighting the Invisible: The Struggle to Eliminate Viral Hepatitis Interviewer: Lauren Heywood Interviewee: Dr. Robert H. Purcell Instructor: Mr. Alex Haight February 17, 2009 Table of Contents Interview Release Form.…………………………………………………………………………..2 Statement of Purpose……………………………………………………………………………...3 Biography…………………………………………………………………………………………4 Historical Contextualization: “A Race for the Cures”…………………………………………….6 Interview Transcription…………………………………………………………………………..23 Time Indexing Recording Log…………………………………………………………………...53 Interview Analysis……………………………………………………………………………….54 Appendix…………………………………………………………………………………………59 Works Consulted…………………………………………………………………………………65 Statement of Purpose Far too often, the study of history is reserved for wars, battles, and economic upheavals, rather than the vital study of the history of scientific and medical research. The purpose of this American Century Oral History project is to enlighten many to the struggles fought and victories won behind the doors of the laboratory, often far out of the public view, with the interview of Dr. Robert Purcell, a main character in the fight against the elusive viral hepatitis. This project aims to impart a verbal illustration to those already aware of and involved in the process of scientific or medical research and to inspire those who are not. Dr. Purcell’s vivid description of the effort against this worldwide epidemic will hopefully provide detail to the frightening abstract of disease and research. Biography Dr. Robert Harry Purcell was born on December 19, 1935, in Keokuk, Iowa. In his youth, he moved to Dallas, Texas, in 1936 and in 1944 to Haileyville, Oklahoma, where he attended high school. As a child, Dr. Purcell was fond of playing football and of nature. Following an insufficient high school education, Dr. Purcell attended Eastern Oklahoma A&M Jr. College, receiving an A.S. in Chemistry in 1955, and Oklahoma State University, where he graduated with a B.A. in Chemistry in 1957. In 1960, Dr. Purcell received his M.S. in Biochemistry as a Student Fellow from Baylor University College of Medicine, and in 1962 he obtained his M.D. from Duke University School of Medicine, also as a Student Fellow. In 1963, Dr. Purcell completed his internship in Pediatrics at Duke Hospital; he traveled to the CDC in Atlanta, Georgia, for eight weeks of epidemiology training to become an Epidemic Intelligence Officer. Following those weeks of training, Dr. Purcell was transferred to Bethesda, Maryland, to work at the National Institute of Health (NIH) on vaccine efficacy trials; he has worked at the NIH ever since. In 1974, Dr. Purcell was appointed to be the Head of the Hepatitis Viruses Section and, in 2001, the Senior Investigator and Co-Chief of the Laboratory of Infectious Diseases at the NIH. In addition, Dr. Purcell has been an elected member of the National Academy of Sciences since May 1988, and a co-inventor of several of the Hepatitis A vaccines. He is a co-inventor of 47 patents and co-author of six books. Dr. Purcell currently lives in Bethesda, Maryland, and has two sons. Historical Contextualization: A Race for the Cures Historian David McCullough, in speaking of the influenza epidemic of 1918, spoke also of the tragedy of all epidemics, saying, “It would be as if today, with our present population, more than 1.4 million people were to die in a sudden outbreak for which there was no explanation and no known cure…Could it happen again? Yes, indeed” (McCullough 7-8). There is very little more terrifying than hundreds of people dying of one devastating disease all around without knowledge of the origin or the remedy. Throughout the world, epidemics take the lives of more and more people, and even animals, in just this way as scientists struggle to find the causes, preventions, and cures for the diseases at hand. The process of discovery and research is long and arduous, but the result, if successful, is irreplaceable. The terror of polio, smallpox, influenza, and countless other epidemics and pandemics was largely due to the mystery and widespread death surrounding them. Thus, to discover a vaccine is to give security to those without the disease, and even hope of a cure to those already infected. Hepatitis is among these epidemics of history, and remained a threat to many lives, even as polio and smallpox were neutralized. Therefore, in order to understand the perspective of someone who participated in hepatitis research, it is important to first examine earlier epidemics, the history of hepatitis throughout the world, and the struggles of hepatitis research in its very early stages. Dr. Rob DeSalle defined an epidemic as, “any disease, injury, or health-related event” that precipitously strikes more than the average number of people in a certain area (DeSalle 153). An epidemic may be confined to the country where it emerged, or it may pass through the surrounding countries as well. If a disease becomes a worldwide epidemic, it is classified as a pandemic. If it is confined to the very small region of its origin, it is considered endemic. Throughout epidemics, the source of movement is usually other humans, animals, or parasites, such as fleas. Wars, increased traveling, trade, urbanization, and climate changes can cause or exacerbate an epidemic or pandemic (DeSalle 153). Epidemiology, or the study of a population’s health and diseases, was important to the discovery and eradication of many of these epidemics. The first documented epidemiology followed the 1832 cholera epidemic in London, England (Friedlander 15). In 1848, Dr. John Snow traced the epidemic to the polluted water of the Thames River. In addition, after the 1854 relapse, he traveled among the citizens of the city, keeping research records that earned him his title, Father of Epidemiology (Friedlander 16-18). Throughout history, men like Dr. Snow helped to discover the source of epidemics around the world, leading to safer living conditions and a higher awareness of disease. However, epidemics ravaged civilizations long before the study of epidemiology began. One ancient epidemic was the historic “Black Death,” also known as the Bubonic Plague, of the fourteenth century (Giblin 11). The first outbreak, recorded between 541 and 544 AD, killed 40 million people (Ryan 120). However, it recurred in the fourteenth century, around the Black Sea. The plague was especially devastating in its mysterious nature; few could even speculate on how one contracted the disease. At first, victims endured rather indistinct symptoms; fatigued and plagued by headaches, they could barely walk. However, after the lymph nodes in the groin expanded to the size of eggs and victims’ blood pressure began to escalate, their nervous systems failed, resulting in a painful death, by the fifth day in most cases (Giblin 11-12). This terrifyingly swift demise threw societies into an uproar. With increased travel to escape and excitement about the disease, it turned into a pneumonic plague, easily contagious by coughing (Ryan 122). Agnolo di Tura, of Siena, Italy, wrote of the mass burials and shocking disrespect for the dead at the time, saying, “This is the end of the world” (Giblin 20). Various societies channeled their terror in several ways in response to the epidemic. In the areas surrounding the Black Sea, the native Muslims claimed that the Christian Italian traders in the area were responsible for the numerous deaths, forcing the Italians to flee for their lives (Giblin 12). Some believed that the disease was due to earthquakes, the Devil, or even a climatic change. Historian Giovanni Boaccaccio wondered in his book, The Decameron, if the plague could be from God’s anger (Giblin 16-18). Many devoutly religious people took to this approach, praying and fasting in hopes of ending the terrible plague, and often casting out misfits and outsiders, as the natives did in the regions around the Black Sea. In Germany, the Flagellants1, after the Catholic Church outlawed their practices, blamed the Jews for the plague, establishing the first holocaust in 1348 (Giblin 37). Many believed that eradication of the Jews from society would bring relief in the plague’s death toll, and the Flagellants took advantage of this suspicion and fear in pursuit of their former respected reputation. Almost as dangerous, physicians of the time knew very little, often harming rather than helping their suffering patients. As a result, many turned to prayer, and to Saint Roch, saint of the plague, who had died in 1327 after a life spent patiently nursing those thus afflicted (Giblin 28). The various reactions to the Bubonic Plague in the fourteenth century increased the fear that accompanied the disease, sending people into frenzy and, with increased travel, spread the disease throughout Europe. In reality, black rats and their fleas spread the Bubonic Plague of the fourteenth century with devastating efficiency on trading vessels. Its origins were of Southeast Asia, and increased trade and travel exacerbated the epidemic (Ryan 4). As more and more residents fled from the Black Sea region, the plague spread to Italy, France, Great Britain, and Germany. Aggravating 1 Flagellants were a group of German Christians who whipped themselves and roved through towns, hoping for God’s forgiveness of their sins. The flagellants commanded much respect from the religious people of the century until they challenged the Church’s power in their declaration that they, not the Church’s ministers, were God’s chosen envoys on earth. In 1349, Pope Clement denounced them and asked officials to outlaw them all over Europe (Giblin33-35). the situation, this increased travel and trade were only one factor of the period of social and environmental upheaval (Ryan 357). The plague affected port cities in particular; in Venice, Italy, the government enacted the first quarantine on a ship infected with the disease. Although unsuccessful, the terrified inhabitants finally began to take a rational approach to ending the devastating pandemic (Giblin 17).
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