Monday, May 23, 2016

The GREATER efficiency of Dawson's impure Manhattan penicillin

Biochemist Dr Karl Meyer's original idea in early September 1940, one approved by his three helping team mates, was to work towards the man-made synthesis of plentiful amounts of pure penicillin within about six months  ----and only then test it clinically on human patients.

Until then,the job of his microbiologist team mates Dr Henry Dawson and Dr Gladys Hobby, assisted by Meyer and his lab tech Eleanor Chaffee, was mostly to grow some penicillium mold and harvest the natural impure penicillin.

Quality makes sense ---- for the  chemist 

All this impure natural penicillin would then be purified to as high a degree as possible by Meyer and Chaffee (losing most of the actual penicillin in the process) - the purity quest being judged a success when the resulting 'penicillin' exhibited a highly specific melting point and would easily 'go into crystal' form.

All this, just so Meyer and Chaffee could then destroy this tiny but fairly pure amount of penicillin, reassured that an analysis of the resulting smaller (simpler) chemical fragments making up this unique new compound would give an accurate description of its structure.

Then the artificial synthesis of newer and better penicillins might become possible.

Only relatively occasionally were Dawson and Hobby's other microbiological skills to be deployed, in testing the bacteria-killing power (if any) of the initial impure natural penicillin, the smaller fragments of purer natural penicillin and the early synthetic penicillin production.

Not at all, during this initial six months, was teammate Dawson to employ his further - and unique - skills as a attending physician, and actually clinically treat human patients with amounts of this early impure natural penicillin.

But then suddenly and unexpectedly, Dawson broke ranks with his friends and teammates and injected some of this highly impure natural penicillin into two patients on October 16th 1940, thus birthing our present Age of Antibiotics.

But why unilaterally break ranks and totally change directions for what was really Dr Meyer's initial show?

After all, Dawson was rather well known for being un-bossy and un-Alpha Male, at least as driven medical scientists generally go.

Quantity makes sense - for the patient

I believe Dawson began to realize that to chemically analysis and synthesize an unknown complex natural biological compound, purity (quality) was an absolute requirement while in the clinical treatment of patients, the opposite (quantity) was the absolute requirement for success.

Let me try to explain, starting at the breakfast table.

To get our needed 100 mg of daily Vitamin C, we could drink a big glass of highly 'impure' orange juice (my choice !) or consume a tiny amount of pure white Vitamin C powder.

But clinically, both produce absolutely the same effect on the patient.

Now lets go from the breakfast table to the hospital ward.

There it would be far far better for the survival of Dawson's dying patients if they got a slow drip of 2500 cc of highly impure (raw in fact) penicillium juice into their blood (containing a total of 10,000 units of pure penicillin) each and every day for four weeks, rather then if they got a shot of 500 micrograms (mcg) of 100% pure penicillin once every four days over the same four weeks.

The first regime - impure regime - would give the patient a total of  280,000 units of penicillin infection fighting power.

That was enough to cure most life-threatening infections in 1940, if delivered early and often enough, (and the ability to deliver early and often was in fact one of a key advantages of taking the easier and more consistent 'impure' route, as Dawson saw it.)

The second regime, only able to fitfully producing its highly purified product, would deliver only 7000 units in total over the same 28 days, not nearly enough to save even a baby from a life threatening infection.

Simply put, early penicillin was so easily destroyed, given our almost totally inability to grasp the measures needed it to render it less chemically fragile, that purifying it always destroyed much of it and each further purification step destroyed more and more and more.

Worse, the more of a very limited amount of human energy and space/money any small penicillin team devoted to purification quality, the less that could be devoted to increasing the quantity production of raw penicillin juice.

Clinically, the human body couldn't care less if one hundred milligrams of Vitamin C or Penicillin is delivered as a small amount of pure white powder or in a big bottle of water and other stuff.

As long as the 'other stuff' was safe when introduced into the body.

That is certainly the case with a drink of orange juice and as for penicillin juice it certainly seemed to be the case in endless amounts of earlier studies with animals and human cells.

Modernity's FALSE GOD : the Cult of Purity

Dawson began to sense, I believe, that the rational separation of natural penicillin production into 'quality is better for the chemist's efforts' and 'quantity is better for the clinician's efforts' was being lost in the unconscious and highly emotional reactions of his colleagues and bosses.

Simply put, during the Age of Modernity, 1875-1965, Purity as an end in itself was raised to far too high a level, even when, as in this case, it made no rational sense at all.

The history of published wartime penicillin efforts is rife with clinicians exalting the high purity of their teams' penicillin, even when the resulting quantities of penicillin were far too small to save the numbers of dying patients they faced.

As these morally broken doctors worshipped the false god of Purity, their hapless patients died.

So much so that, whether as Nazi doctors or as Allied doctors, WWII was hardly Organized Medicine's finest hour ...

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