DOCTORS' LOUNGE
ASKING THE RIGHT QUESTION - WHY? John A. Lloyd, MD
I
t is common knowledge that the practi-
tioners of medicine today owe much (if
not everything) to the contributions and
discoveries of earlier generations of scien-
tists, physicians and even the practitioners
of folk medicine. In his book, American
Folk Medicine, Clarence Meyer quotes an
unnamed professor of medicine: “If modern
science had been open-minded about ageless secrets of medical
folklore, antibiotics would have been brought to light many years
earlier.” A case in point is that ancient Egyptians had a practice of
applying moldy bread to infected wounds. Hence, the beginnings of
medical knowledge, as well as each subsequent medical milestone,
can with certainty, be traced from antiquity to the present and
from folklore to modern scientific research. A recounting of these
journeys can be exciting as well as reassuring, and one will often
discover that many of the discoveries were preceded by someone
asking the question, “Why.”
One of the most familiar of these medical landmark events is
the discovery of penicillin, which marked the true beginning of
modern antibiotics. It is a familiar story, as noted, but a review is
always exciting. Apparently, no one paid attention to the ancient
Egyptians until 1928, when Alexander Fleming (1881–1955), Pro-
fessor of Bacteriology at St. Mary’s Hospital in London, returned on
Sept. 3, 1928 from a holiday. Professor Fleming, while reviewing his
petri dishes on which he was growing colonies of Staphylococcus,
discovered a mold growing on one area of a dish. He noted a clear
area around where the mold was growing. The mold appeared to be
capable of inhibiting bacterial growth. No doubt, many would have
thrown out the petri dish and started over. Sir Winston Churchill
said it best: “Men occasionally stumble over the truth, but most
of them pick themselves up and hurry off as if nothing had hap-
pened.” However, unlike “most of them,” Professor Fleming asked
the question, “Why?” He thus discovered that the “mold juice” was
capable of killing not only Staphylococcus but also a wide range of
bacteria. Dr. Fleming’s bombshell news was jumped on by a host of
researchers working with “mold juice.” In 1939, Dr. Howard Florey
and colleagues at Sir William Dunn School of Pathology developed
the lifesaving drug penicillin, which was ready for use during WWII
in 1943. And, as is often said, “The rest is history.”
Every landmark medical discovery story provides its own ex-
citement. For instance, a group of German scientists in the 1920s
identified an apparent link between cigarette smoking and lung
cancer. Dr. Evarts Graham did the first successful single-stage
pneumonectomy for lung cancer in 1933 at Barnes Hospital at
Washington University in St. Louis. His patient was Dr. James Lee
Gilmore, who lived another 30 years as his friend. But it was not until
1950 that Sir Richard Doll reported in the British Medical Journal
data that supported a definite association between smoking and lung
cancer. Dr. Graham and his partner Dr. Ernst Wynder published in
The Journal of the American Medical Association (JAMA) in May
1950 their “Tobacco Smoking as a Possible Etiologic Factor in Bron-
chogenic Carcinoma: A Study of 684 Proved Cases.” They reported
that 96.5 percent of their patients were moderate to heavy smokers.
Dr. Graham stopped smoking, but years later died of lung cancer.
Sir Richard Doll and his colleague Sir Austin Hill had been
studying this in London and published in the British Medical Journal
in September 1950 a study of lung cancer patients in 20 London
hospitals. They wrote, “The risk of developing the disease increases
in proportion to the amount smoked. It may be 50 times as great
in those who smoke more than 25 cigarettes daily, compared to
nonsmokers.” They followed up with the prospective cohort study,
the British Doctors Study, over 40,000 of them, nearly all males,
which ran from 1951-2001. This was groundbreaking work in
epidemiology that demonstrated over 50 years the precise risk of
every devastation from smoking. Multiple contributions followed
and although the world resisted the findings, scientific acceptance
of them led to the Surgeon General’s report in January 1964.
Every remarkable story is worth retelling, whereupon one finds
that someone asked the right question: the question, “why.” There
is the metaphysical why: this seeks answers to the unknowable, the
ultimate causes of everything. The scientific why grows from some
perceptive observation, one that builds on previous mysterious
phenomena. Perhaps penicillin would have been discovered by
someone else, but how many lives would have been lost as a result
of the delay? Albert Einstein stated the point in a more elegant way:
“The important thing is not to stop questioning. Curiosity has its
own reason for existing.” Progress in medicine will likely continue
only so long as curious minds continue to question and continue
to pursue answers.
Not many medical practitioners or researchers make landmark
discoveries that will change the future of medicine or that will alter
patient outcomes. However, all who provide medical care to their
patients benefit from those giants of medicine who chose to ask,
“why” and who continued their pursuit until there were answers.
The message seems clear. Every physician involved in patient care
has his or her “why moment” (often every day). We should pursue
our questions with the same resolve and determination as our elders
before us. Those who ask, “why” do not deal solely with symptoms,
but with causes and reasons. Our search for answers can make pos-
sible better patient outcomes, comforts and prognoses. Perhaps we
should heed the advice of Gandhi: “Infinite striving to be the best
is man’s duty, it is its own reward.”
Dr. John Lloyd is a pulmonologist with Louisville Pulmonary Care, PLLC.
JANUARY 2020
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