Nobel laureates: Medicine and physiology

I was fortunate to spend a couple of days in Stockholm, where I made a point of visiting the Nobel Institute in the old part of the town (Gamla Stan). From the outside, it is an impressive building: on the inside, you could see pictures of all the prize winners, and learn what brought them international recognition. Alfred Nobel was born in Stockholm in 1833. Half of his eight siblings died in childhood. When his father, an engineer, had success with machine tools and explosives whilst working in St Petersburg, he prospered: the family moved to Paris where school tuition was more available. Alfred was a bright kid: he became fluent in six languages, and passionate about engineering and chemistry. By mixing kieselguhr (a porous silaceous earth) with nitroglycerin, he created a much more stable (and usable) product, DYNAMITE (1867). Mixing cellulose with nitro brought about an even more powerful product, GELIGNITE. There were still risks involved: his brother died at one of his factories in an explosion. His two other brothers made their fortunes developing oilfields in the Caucasus, and Alfred became very wealthy too. He had over 350 patents to his name, the first of which was registered when he was 24. Although he and his family owned the Bofors Steel & Armaments company, he hoped his inventions would advance public works (blasting earth to make tunnels, canals, railways and roads) and eventually promote peace. In his will, he made specific mention of how his wealth was to be distributed. Nobel Prizes were created in Literature, Medicine and Physiology, Economics, Chemistry, Physics and Peace—awarded to those who made the greatest contributions to mankind in the previous year. Recipients are decided upon by the Swedish Academy of the Sciences.Read: Medical WisdomSo, who are these remarkable people? Let me mention just a few:Sir Robert Ross for his work on malarial infection (1902)Robert Koch for his work on tuberculosis (1905)Frederick Banting and JJR MacLeod for their discovery of insulin treatment of diabetes (1923)Karl Landsteiner, for his discovery of blood groups (1930)Alexander Fleming, Ernest Chain and Howard Florey for their discovery of Penicillin its curative value (1945)More recently, you will see groups of researchers awarded this prize. In the last few years:James Allison and Honjo Tasuku for the discovery of cancer therapy by inhibition of negative immune regulation (2018)William Kaelin, Peter Radcliffe and Gregg Semenza for discoveries of how cells sense and adapt to oxygen availability (2019)Harvey Alter, Michael Houghton and Charles Rice for discovery of hepatitis C virus (2020)David Julius and Harvey Patapoutain for discovery of receptors for temperature and touch (2021)Svante Paabo for discoveries concerning genomes in extinct hominis species (2022) Read: Hurry up and waitAshrafian et al1 noted that clinicians are less likely to garner recognition than previously. It is interesting that some of the notable ‘discoveries’ do not necessarily have proven benefit to mankind: conversely, many public health advances that save millions the scourge of morbidity or mortality go unrecognized. I believe it is the latter group that clinicians once were most notable in representing. What changed? Patient characteristics? Physician engagement? Clinician goals and objectives?My definition of a clinician is a person with substantial medical training who interacts with patients, and in so doing identifies health goals and disease characteristics in small and large populations. Often, it is the process of extrapolation (from the specific to the general, from the individual to the large cohort) that leads to new insights in prevention, diagnosis and treatment. I’d like to highlight two giants in Medicine: Robert Ross and Robert Koch.Robert Ross was born in India in 1857, trained in London, and studied Public Health and bacteriology. He believed parasites in the blood were transmitted by Anopheles mosquitos, and confirmed this in Secunderabad in August 1897. In 1899, he resigned from the Indian Medial Service, and worked for the newly established Liverpool School of Tropical Medicine. He was active in expeditions to investigated control measures in various high-prevalence sites (Egypt, Panama, Greece, Mauritius). He was awarded the Nobel Prize in Medicine in 1902 and went on to receive many honorary degrees and awards. He was a consultant physician on tropical diseases during WWI. The Ross Institute was opened in 1926, which he ran until his death in 1932. He is also noted as a mathematician, epidemiologist, editor, novelist, musician, composer and artist.2 Robert Koch may have spent long hours in the Bacteriology and Pathology lab, but his insights into tuberculosis were gained from clinical practice and a strong understanding of determinants of disease and its transmission in human populations. Born in Clausthal, Germany in 1843, and trained in Gottingen, he practiced in Hamburg, Langenhagen and Rackwitz. He studied anthrax, prevalent among farm animals, proving that disease transmission could be demonstrated by the inoculation of the bacterium into mice. He discovered the spore stage of the organism, which conferred resistance to unfavourable conditions: this work gained international acclaim (1876). He studied other microbial infections, and in his new lab in Berlin, developed techniques for culture and classification. He discovered the tubercle bacillus (1882), and the following year the vibrio that causes cholera. In 1896 he went to Africa and India, working on malaria, blackwater fever, and plague. He also studied typhus, babesiosis and trypanosomiasis. Among many honors, he was awarded the Nobel Prize in 1905.3 He died in Baden-Baden in 1910.I suspect everyone knows of individuals who deserve recognition and reward for advances in care, advances that are measurable, sustainable, meaningful and timely. Maybe in fields like patient education, or lifestyle modification in substance abuse, or systems development in healthcare. Robert Gallo (who discovered HIV), Rosalind Franklin (work on DNA structure), Albert Schatz (streptomycin) and Roy Calne (organ transplantation) did not receive this award, and maybe these oversights will be corrected one day. The Nobel Prize acts as a ‘positive force’ in modern science. Nobel wanted to recognised huge accomplishments in Medicine and Physiology that benefitted mankind. In the first 30 years, 79% of Nobel Prizes were awarded to clinicians: in the last 30 years, 26%. Nobel laureates are more often polymaths but specialise in one field of work to maximise their chance of success.4 Often, their output drops off following this award.5Medicine is changing. Not only as a profession, but as a science, a study of people and populations, of genes and molecules. Recognition and reward are major motivating forces for all of us: let us remember the greats and celebrate new visions. As Newton once said:“If I have seen further, it is because I have stood on the shoulders of giants.”ReferencesNobel Prizes in Medicine: are clinicians out of fashion? Hutan Ashrafian J et al. R Soc Med. 2011 Sep; 104(9): 387–389. doi: 10.1258/jrsm.2011.110081. PMID 21881091Ross and the Discovery that Mosquitoes Transmit Malaria Parasites. CDC: malariaRobert Koch Biographical. The Nobel PrizeAcademic background of Nobel prize laureates reveals the importance of multidisciplinary education in medicine. Li, D et al Social Sciences and Humanities Open (Elsevier Press) 3(1) 2021How Nobel Prizewinners Get That Way. Wilson, M. The Atlantic Dec 1969.

Casebook of a Community Internist

Nobel laureates: Medicine and physiology

Register for free access or login.

Blog Author

Hector Baillie

Related Topics