Abstract
Doctors and scientists have been experimenting on themselves for centuries. A new BBC series considers the heroic successes—and spectacular flops
When he was about 10 years old, my son once said, in a fit of philosophical insight, “Someone has to sit next to the naughtiest boy in the class.” He was right, of course, and his generalisation also applies to medicine. Someone has to go first, whether it is a new operation, drug, procedure, or experimental finding. For all of our experimental protocols, animal testing, and ethics committees, if it concerns human beings, someone has to be the first.
In this series of four engaging programmes for BBC television, Michael Mosley examines the role of self experimentation within medicine during the past two centuries. He divides his programmes by themes; anaesthesia, vaccines, diet and disease, and infections. Mosley, a doctor, has a wonderfully boyish enthusiasm for medicine and is a skilful communicator. He combines a nice mix of history and contemporary themes, interviewing several groups who still practise the traditional craft of using themselves as their experimental subjects. He is keen on experimental participation, subjecting himself to analysis of bodily scrapings and fluids, breathing nitrous oxide, altering his diet, and allowing himself to be bitten by mosquitoes. We get lots of views of Mosley changing into surgical gear, peering down microscopes, and being subjected to mild discomfort.
Mosley is particularly moving at the graves of his dead heroes and good, too, at seeking out some of their descendants to interview. Thus, we see the son of Fred Prescott, who injected himself with curare to observe its paralysing effects; the widow and son of Victor Herbert, who gave himself megaloblastic anaemia through a diet deficient in folic acid; the grandson of Joseph Goldberger, whose work on pellagra was pioneering; and a descendant of Jesse Lazear, who died, aged 34, in the yellow fever experiments in Cuba in 1900.
Mosley presents failures and successes, the mundane and epoch making, in the same excited tone. John Hunter was a great experimentalist and surgeon, but his experiments on syphilis and gonorrhoea were unfortunate, to say the least. He was probably his own subject, but the fact that he acquired both diseases from inoculating his penis with the fluid from a urethral discharge of someone assumed to be suffering only from gonorrhoea, set back research on the two diseases for more than half a century. Hunter's contemporary William Stark literally starved himself to death, subsisting on bread and water, gradually adding other nutrients—but too late, as scurvy (and possibly other conditions) finally killed him. He recorded his diet and symptoms in minute detail, but they had little impact on contemporary thinking. Somewhere, perhaps, Dr Mosley ought to have reflected more fully on the fact that self experiments are often one-off events, without proper control. Their interpretation and reporting can be bound up with the experimenter's subjective feelings. They are double edged, needing thoughtful design and execution to be top drawer experiments rather than mere acts of bravery, exhibitionism, or flamboyance.
Mosley does show how many modern medical innovations involved self experimentation, although adopting that as his recurrent theme requires the occasional historical sleight of hand. Louis Pasteur's importance gets him full billing, but his offer to be injected with his new rabies vaccine was not accepted by his colleagues. Robert Koch was never a self experimenter, but he is also part of Mosley's story. Koch's main German rival, Max von Pettenkofer, famously drank a phial of cholera germs, to refute Koch's claims to have discovered the organism causing the disease. Pettenkofer lived to tell the tale, so interpreted his self experiment as proof that cholera is caused by water sodden soil, not the comma bacillus. He later died by his own hand, but not from cholera.
Mosley brings his story up to the present, and two of his interviews stand out as powerful testimony to the continued importance of this mode of experimental investigation. Hilary Koprowski, born in 1916, is one of the forgotten heroes in the development of polio vaccines, but his eloquent description of his work, and the reasons why he was marginal to the media hype that polio vaccine enjoyed in the 1950s, are wonderful footage. Barry Marshall, the subject of an earlier Mosley documentary, describes his work on Helicobacter pylori as a cause of gastritis and peptic ulcer. His research with pathologist Robin Warren reminds us yet again that simple experiments are often the best, and there are still Nobel Prize winning discoveries to be made with ordinary tools at the bedside and in the laboratory.
He subjects himself to analysis of bodily scrapings and fluids, breathing nitrous oxide, altering his diet, and allowing himself to be bitten by mosquitoes