We are often told “follow the science.” Yet, at times, it seems that science follows an astute and unanticipated observation. Can you give some examples?

Your Menopause Question: We are often told “follow the science.” Yet, at times, it seems that science follows an astute and unanticipated observation. Can you give some examples?

Our Response: Serendipity is defined as the ability to made fortunate discoveries by accident. Or, as Louis Pasteur over a century ago called it, “Fortune favors only the prepared mind.” In science, it often is the educated eye that extracts something new and important out of otherwise mundane events. And, of course, not all discoveries made this way turn out to be relevant or contributory. Some, in fact, can be harmful. Here are some examples to reinforce these concepts, observations that I call “the good, and the bad.” I reference, for the interested reader: Lyons AS and Petrucelli RJ (1997). Medicine: An Illustrated History, Abradale Press, Harry N. Abrams, Inc. Publishers.

THE GOOD:

The Viagra Story: It is acknowledged that the creation of Viagra® (Sildenafil) has been a great contribution to the treatment of erectile dysfunction. But Viagra® was not initially developed for that purpose. Instead, it was being offered to men to treat their hypertension. At some point, data showed that Viagra® did not help lower blood pressure. So the company asked the study participants to return their pills. But no one would. We now know how that worked out.

The Penicillin Story: In 1928, Alexander Fleming, upon returning from a trip, observed in his discarded petri dishes a mold that prevented his Staphylococcus aureus bacterial colonies from growing. The mold had originated from another laboratory in that building where Penicillium mold was being studied. With time, that discovery became one of the great antibiotic contributions to infection treatment.

Bone Health and African Tribes: You probably thought that medications designed to slow bone density loss in menopause originated in the laboratory. But one important advance in 2001 originated in the African jungle (Delgado-Calle, 2018). Noting that certain tribes had unusual orthopedic characteristics including gigantism, large skulls, and overgrowth of bone structures, scientists ultimately attributed these abnormalities to defects in a protein called sclerostin (SOST). This protein normally helps control bone formation and bone resorption, working through the SOST gene on chromosome 17. Alterations in the gene lead to orthopedic deformities. The role of gene defects in the SOST gene in postpartum osteoporosis is now under evaluation. Once again, an astute observation led to a significant medical contribution (Hay, 2016, and Yu, 2022).

Handwashing in Obstetrics: In the early 1800s, one of the most feared outcomes in obstetrics was postpartum infection, often leading to maternal death. Many scientists were aware of bacterial infections, but how they got passes from one patient to another was still being debated. Ignaz Semmelwise (1818-1865), an obstetrician at Allgemeines Krankenhaus, watched as up to 20% of his patients, delivered by medical students or physicians, died from infection. But, he noted that the midwife service ward in that same hospital had a much lower rate of maternal infection. What distinguished the two wards was that medical students and physicians worked on Semmelwise’ obstetric ward and performed autopsies on women who had died. The back and forth responsibilities of these care providers were carried out without any effort for cleanliness. Sensing that germs were being transported from the autopsy room to the obstetric ward, he initiated handwashing with soap and water. Soon after, the maternal death rate from infection on the medical student/physician ward was less than 1%.

THE NOT SO GOOD:

Ethanol for Preterm Labor: It is hard to believe that alcohol would be promoted by obstetric care providers. But in the late 1960s, a professor in pediatrics at a major university was studying the hormonal mechanism of postpartum breast milk letdown. Using a mouse model, she found that ethanol reduced oxytocin, the pituitary hormone that promotes breast milk release. By chance, her husband was a professor in obstetrics and gynecology. Upon learning of his wife’s observations, he proposed and then initiated a protocol for intravenous 6% ethanol (equivalent of table wine) to be given to women in preterm labor. During a several year period in the early 1970s, until oral terbutaline was introduced later in 1970, this was the management in many hospitals (Schrock, 1989, and Haas, 2015). Of course, the women became violently intoxicated, some pulling out their IVs or falling out of bed. How do I know this? I was a resident in OB/GYN training and took care of many of these patients. So now you know the rest of the story.

First HIV Diagnoses: Today, human immunodeficiency virus (HIV) is considered a chronic condition that, with proper medication, allows an infected patient to live a long life. But, when it was first diagnosed, the study subjects were men from Haiti. The immediate reaction from the press (and others unfortunately) was that HIV originated from Haitian men. Lesson learned: quick responses by the media when not all the information is available should lead to more information, not more instantaneous reporting, and besmirchment of individuals.

Origin of the Polio Virus: The polio virus, first identified in 1909, was devastating, leading to over 55,000 cases of paralytic poliomyelitis in the United States. Because waves of polio infections emerged during the summer months, it is no surprise that, in the early 1940s, the immediate conclusion was that the polio virus originated from swimming pools. That, of course, led to closure of all swimming pools. Yet, by 1955, within three years of the introduction of the Salk vaccine, there were fewer than 200 cases. The pictures of children in iron lung machines are haunting. But, quick and unsubstantiated conclusions often do more damage than benefit.

SO ARE WE NOW SO SMART?

Based on these examples, one might conclude that the author of this article was free of any misjudgments. Not so. As an intern in OB/GYN, I visited an art gallery in Honolulu, Hawaii, where I was trained. In that gallery were two items, the same price. One was a seascape. The other was a book of 24 personal hand etchings by a relatively unknown artist named Salvador Dali. Years later, I gave the seascape away. Bad choice. Thanks for listening.

James Woods | 8/1/2022

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