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Anthropological Niche of Douglas W. Hume
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Internet Source: Medical Post, v.37(16), pg 21, April 24, 2001
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Medical fact or fiction?

Three books--two nonfiction and one novel--explore the tricky business of disease prevention. But which of these accounts is to be believed?

By CHARLES GODFREY

Equal aliquots of fact and fiction are being transfused into the body politic these days to control the daily craving for the fix of a medical breakthrough before noon. In spite of a host of reporters, pharmaceutical PR types and an abundance of ink, the consumer is flummoxed by these two f-words: fact and fiction. Three recently published books that examine the edges between medical fact and fiction are sure to add to the discussion.

In The River, Edward Hooper maintains in a 1,070-page, closely indexed, meticulously footnoted study, that certain batches of CHAT, an experimental polio vacine developed by Dr. Hilary Koprowski in Philadelphia in the 1950s, was prepared in a substrate of chimpanzee kidneys. He further argues a simian immunodeficiency virus, latently present in some of those kidneys, may have infected a proportion of the population of Central Africa between 1957 and 1960.

This, according to the writer, sparked the AIDS pandemic. The book created a storm of controversy. Dr. Koprowski and Dr. Jonas Salk had thrilled the world with their discovery of an oral polio vaccine. This came, as Hooper details, after several disastrous attempts in the U.S., with deaths of scientists, researchers and volunteer subjects, from vaccines that were virulent rather than prophylactic.

The lead-up to the actual announcement by Dr. Salk is the stuff of heroes, with physicians sacrificing reputation and their own lives to conquer this scourge.

However, when Hooper's curiosity was tweaked by the death of a British sailor in 1958 with an unexplained rapid disease course--supplemented by a report by Dr. John Barrie, pathologist at the Toronto General Hospital, of the death of a Japanese-Canadian with Pneumocystis carinii--there started a trail of investigation, which generated confirmations and denials across the scientific world.

While the book is fascinating, even more gripping is the flood of opinions that argue the ''who, what, when, where and why'' of the thesis.

Patrick Tierney, the author of Darkness in El Dorado, became engaged by a mystifying outbreak of measles among the Yanomamo of Venezuela. This tribe had been studied by Napoleon Chajnon, a world famous anthropologist, who included in his book that these were fierce people who had demonstrated Darwinian manifest destiny by evolving into brutal warriors. Chajnon proclaimed they were a virgin society, immunologically speaking.

This study attracted the attention of the U.S. Atomic Energy Commission, which was interested in determining what immune properties were present in such a cohort, compared with what was known of the survivors of the Hiroshima atomic bomb blast. Tierney details, with a wealth of evidence, that a renowned geneticist, James Neel of the University of Michigan, was commissioned to vaccinate the natives with a measles vaccine and then to measure the titre of immunity.

Tierney was not able to explain why Edmonton B. vaccine was used, as there was evidence it caused, rather than protected against, the disease. By examining the time sequence of the first appearance of the overwhelming measles epidemic with the possibility the vaccination had been carried out prior to that event, Tierney points an accusing finger.

The issue has not been settled. Numerous pillars of anthropology came to the defence of Neel and Chajnon (who had been a participant in the immunization program). Once again, a well-documented book, scrupulously investigated, ran into a solid wall of denial and denigration.

John le Carre does not eat carrion. He goes for live meat. In his new novel, The Constant Gardener, based in Nairobi, a non-governmental organization worker is murdered in a game park. So what is the connection? She was about to publish a carefully researched article stating an international pharmaceutical company had developed a tubercular prophylaxis, which would protect the world against an imminent plague of tuberculosis.

Le Carre's mystery story is no deeper or fanciful than that of Hooper or Tierney. All three are working with a similar theme: disease prevention has become a tricky business. Arborizing through the three works is the Heart of Darkness theme, where somehow the do-gooders have fulfilled Darwin's speculation.

There is only a thread separating fact from fiction. Was it fiction with le Carre? Was it based on fact? Did scientists use a vaccine such as the Edmonton B. when it is acknowledged it was a dangerous procedure? Did Belgian scientists cross the species barrier, creating a new disease?

Only time will tell--and time is something the average African does not possess.

Charles Godfrey works in rehabilitation medicine at St. Michael's Hospital in Toronto.