Transformations in healthcare have never been easy or safe

Some of the first American children to receive the long-awaited Salk polio vaccine in 1955 were in San Diego, California.Credit: Bettmann / Getty

You bet your life: from blood transfusions to mass vaccination, the long and risky history of medical innovation Paul A. Offit Basic (2021)

Author Paul Offit sits on the U.S. Food and Drug Administration’s COVID-19 Vaccine Advisory Board. An international expert in vaccine development, he co-invented the rotavirus vaccine. He wrote many books, some prophetic, like his 2010 treatise Deadly choices: how the anti-vaccine movement threatens us all – and is an attending physician in the infectious diseases division of the Children’s Hospital in Philadelphia, Pennsylvania.

In short, he thinks a lot about the risks and benefits of medical care.

His latest book – You bet your life – couldn’t be more timely. Using the stories of key patients, he weaves a tale of incredible transformations in medical care that weren’t easy or safe linear progressions. Charting some of the “greatest breakthroughs,” Offit focuses on the long history of error, neglect, paternalism, lack of oversight and the many casualties along the way, including individuals and public trust.

The book breaks down key developments into three parts, spanning a wide range of medical breakthroughs – from heart transplants and anesthesia (“Risk”) to antibiotics and x-rays (“Supervision”) and, finally, chemotherapy and chemotherapy. gene therapy (‘Serendipity’).

The stories are compelling and filled with fascinating detail, many of which date back to the days of ethics review boards. Offit talks about slightly crazy doctors and dentists playing with anesthetics; surgeons granting heart to people unable to prevent organ rejection; and potentially life-saving treatments have gone wrong.

A poignant example is the story of folic acid antagonists in chemotherapy. Pediatric pathologist Sidney Farber (founder of the Dana-Farber Cancer Institute in Boston, Massachusetts) read work on mice published in 1945 that demonstrated a miraculous reduction in cancer through the use of “folic acid”. Words were carefully kept in quotes in early research publications because no one was sure what the snippets used actually contained.

In Farber’s rush to help 11 pediatric patients with end-stage acute lymphoid leukemia, he treated them with a purified form of folic acid that he thought was safer. This was before the bench scientists found out that the extract they had used to treat the mice was actually not pure folic acid, but an antagonist that blocks its effects. Farber inadvertently precipitated the deaths of the 11 children.

In ‘Risk’, Offit describes the desperation of individuals such as Louis Washkansky. Dying of congestive heart failure, Washkansky’s only hope was a new heart. But no human had ever received such a transplant. Among other options, he chose to have Christiaan Barnard operated on in 1967. Washkansky only lived 18 days. He was at least aware of the experimental nature of the treatment. Others weren’t, like Hannah Greener, a girl who died in the 1840s after being given chloroform, an anesthetic that had just been used.

The section called “Supervision” is where Offit feels most comfortable discussing antibiotics and vaccines. In the context of the COVID-19 pandemic, the story of how other vaccines have been developed is compelling. Offit centers his story around Anne Gottsdanker. In 1955, aged 4, she received the polio vaccine that Jonas Salk had just developed for a world desperate for a reprieve from this devastating disease.

In a heartbreaking description, she remembers “lying in the hospital and not being able to move anything”. Salk’s polio vaccine required the virus to be killed as part of its production. Due to a lack of government surveillance and botched manufacturing as vaccine production increased, Anne was one of 70,000 people who were inadvertently given the live polio virus. The tragedy, called the Cutter Incident after the name of the company that manufactured the faulty doses, left 164 people severely paralyzed and 10 dead. (Offit wrote a book in 2005 about the episode and how vaccine safety subsequently improved.)

The final section, “Serendipity”, traces the work that led to chemotherapy and gene therapy. Offit is a master of the art of weaving several threads of a story, describing the ups and downs of research and the unexpected discoveries that lead to new treatments. He describes the first person whose tumor was successfully treated with a folic acid antagonist in 1946-1947: Babe Ruth, the American baseball star. Such a footnote is a reminder that new drugs often go to well-connected people (remember the cocktail of drugs that Donald Trump received as US President during his hospitalization with COVID-19).

In the pursuit of exuberant storytelling, some points are exaggerated and some facts and dates are wrong. For example, Offit today calls heart transplants “as common as bypass surgery”, which is far from being the case. Choosing to provide a bibliography for each chapter without a specific reference makes it difficult to find and read interesting information, such as the statement that couples from an unspecified country did not have the right to marry if they had different rhesus blood groups.

Offit’s most important messages are contained in a short epilogue. Here he reflects on the downstream consequences of unforeseen tragedies that may follow new discoveries. Injury to a few can be detrimental to many, if erosion of trust means people withdraw from prevention or treatment. For example, in 1956 in the United States alone, polio crippled 15,000 unvaccinated people due to reluctance to get vaccinated following the Cutter incident.

Unfortunately, medical history is repeating itself. As Offit concludes, people are much more afraid of doing something that has a slim chance of harming them, such as having a COVID-19 vaccine, than of not doing something that is likely to cause harm – like remain unprotected from a virus that has killed millions of people in less than two years.

Competing interests

The author declares no competing interests.

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