The Editors are pleased to present a lighly edited e-mail exchange that took place recently among some of the particpants.
Victoria Harden: David Guston writes,
[O]ne might imagine what the character of the private sector response might have been to AIDS in the early 1980s: Driven by ‘consumer’ fear of contagion and prejudice against homosexuals and immigrants, and absent sound morbidity and mortality data from the Centers for Disease Control and the technocratic but also compassionate mindset of folks like Tony Fauci at the National Institute of Allergy and Infectious Diseases, the response would have been (and nearly was anyway) brutality toward gay men, drug users, and Haitians (and later Africans). Many thousands or tens of thousands more would have died, and not just in the gay community.
Activists like Larry Kramer of course castigated the Reagan administration for its neglect of the crisis. But one should be careful not to conflate policy decisions in the White House, which affect the NIH grants program, with research done in the NIH intramural program, which has the flexibility to reorient research quickly. Also, political decisions affected medical care for people with AIDS and their civil rights, which are important issues but not directly related to the question of funding for biomedical research. The AIDS activists were critical in maintaining political pressure on Congress for AIDS funding, but they sometimes failed to understand that money alone would not produce a cure or vaccine. If that were true, cancer would have been cured long ago.
Terence Kealey: Private foundations have indeed done work on infectious diseases, even on diseases that carried with them moral disapproval – like syphilis. Howard Florey’s major funder when he was developing penicillin was the Rockefeller Foundation.
Ah ha, I hear you say, but penicillin wasn’t the first antibiotic, Salvarsan 606 was. Quite so, it was. Here is an extract from Wikipedia:
In 1906 Ehrlich became the director of the Georg Speyer House in Frankfurt, a private research foundation affiliated with his institute. Here he discovered in 1909 the first drug to be targeted against a specific pathogen: Salvarsan, a treatment for syphilis, which was at that time one of the most lethal and infectious diseases in Europe.
Victoria Harden: Yes, penicillin was initially developed with private sector funding. Once its value was demonstrated, however, Florey traveled to the United States and got A. N. Richards, head of the Committee on Medical Research of the Office of Scientific Research and Development (OSRD—Vannevar Bush’s wartime U.S. government science entity) to be the central point for information about penicillin throughout the war, and the U.S. War Production Board oversaw collaboration among the network of U.S. companies producing penicillin. For more on this, see Robert Bud, Penicillin: Triumph and Tragedy (Oxford, 2007).
And to get technical, Salvarsan was not an antibiotic; antibiotics are substances produced by or derived from certain fungi, bacteria, or other microorganisms that destroy or inhibit the growth of other microorganisms. Salvarsan was an antimicrobial chemical which Ehrlich found targeted spirochetes. The treatment was long and not pleasant, so many people never completed it. But it was viewed as a “magic bullet,” and scientists continued to search for other antimicrobial drugs. They were unsuccessful until the late 1930s, when the sulfa drugs proved effective against streptococci. All this research was funded by the private sector. World War II marked the final advent of significant government funding for science in the United States.
One more story about World War II and the transition to government activity in science: In 1937, Max Theiler at the Rockefeller Institute attenuated a strain of yellow fever virus that was used to develop an effective vaccine. The Rockefeller Foundation began producing the vaccine, and a U.S. Public Health Service physician, Mason Hargett, was sent to the Foundation’s production lab in Brazil to learn the method. While there, he developed a way to make the vaccine without needing human serum to stabilize it (he called it an “aqueous-based” vaccine). After 1943, when U.S. troops fell ill with “jaundice” (hepatitis B, but hepatitis viruses had not been isolated, so it wasn’t differentiated) after receiving injections of the Rockefeller yellow fever vaccine and the contamination was traced to the human serum used in production, the U.S. government sent Hargett to the PHS Rocky Mountain Laboratory in Montana (where yellow fever mosquitoes wouldn’t survive the winter if they got loose), and he made the yellow fever vaccine without human serum for the remainder of the war. Afterwards, the government turned production over to the private sector.
Terence Kealey: First, let me thank you for the interesting history that you provided. But I might also just say that you’ve – we’ve – touched a British nerve over penicillin. We Brits think you Americans took advantage of the fact that we were then fighting World War II alone, and that we simply didn’t have the resources to develop penicillin on top of everything else, so you … er … stole it from us (wasn’t there something about patents, I can’t now remember the details?) similar to the way Roosevelt used lend-lease to requisition all our imperial bases.
I expect there’s another, more benign, explanation for the fact that we in Britain ended up paying licence and patent fees to America for decades for the use of penicillin, but if we can’t nourish the odd sense of grievance, what pleasure can we derive from life?
David Guston: Very funny, Terence. What Victoria also leaves out from the above, if I recall my penicillin history correctly, is that when war-time production dropped the cost of the drug significantly, the U.S. NIH was left with residual funds that were supposed to buy penicillin but now could be re-purposed, and thus (in part) was born the grants program at NIH.