Alpha Omega Alpha Medical Honor Society

Intelligent design and the Age of Endarkenment
Gerald Weissmann, MD

Fans of rational science are living in the best of times and the worst of times, and I’m not talking about A Tale of Two Cities, but a tale of two cultures. The prospects for modern science are splendid while our larger culture seems caught in a slough of despond. In the last half century our scientific culture has landed on the moon, sampled Mars, and deciphered the human genome. Our new technology permits us to clone genes on chips and dial China from the Palm in our hand. The biological revolution has cracked new diseases as they arose (Lyme, HIV, SARS) and blunted the hurt of the old (cancer, cardiovascular disease, inflammation). We’ve doubled the longevity of fruit flies and roundworms in the lab and increased human life span in the developed world by a decade and a half.
Meanwhile, much of society at large is beating a hasty retreat to the dark ages: the wars of religion are back, superstition threatens our schools and Bible-thumpers preach that evolution has it wrong. Our heritage of reason, formed in the age of Enlightenment, is becoming eclipsed by a wave of Endarkenment.

From amusement to anger: Samuel Clemens’s shifting attitude toward patent medicine
K. Patrick Ober, MD

Samuel Clemens had a lifelong relationship with patent medicines. He ingested them as a child (sometimes against his will), wrote about them, and even encouraged his brother to market his own brand. A review of his public and personal writings throughout his lifetime demonstrates that he underwent a progressive evolution in his attitude toward the patent medicine industry. Clemens could use his humor as either a gentle gift or as a sharp weapon. He treated patent medicine fairly gently in his earlier writings, and even in his later reminiscences about his early days in Hannibal, but his later writings became far more caustic and exhibited an increasing level of anger and contempt toward patent medicine’s deceitful methods.

Gloria in absentia: Walter Reed, James Carroll, and the ethics of authorship
Charles S. Bryan, MD, MACP

Walter Reed receives popular credit for proving mosquito transmission of yellow fever, but it has been suggested that he, in effect, appropriated the findings of the other members of the United States Army commission of which he was chair: James Carroll, Aristides Agramonte, and, especially, Jesse W. Lazear. Correspondence between Carroll and his wife, and between Carroll and Reed, recently made public, tends to exculpate Reed from three innuendos: (1) that his explanation for leaving Cuba in August 1900, the day after the investigators agreed to self-experiment, was spurious; (2) that he asked that Lazear’s notes be set aside for his own use, to the exclusion of others; and (3) that he hastened back to Cuba in October 1900 after learning that his colleagues had largely proven the mosquito hypothesis. However, Reed’s fame based in part on first authorship raises issues that persist today, notably appropriate attribution of credit for scientific discoveries and maintenance ofmutual respect between and among investigators.

Ramshackle lopsided research
Jack Coulehan, MD, MPH

This essay tells the story of two randomized placebo-controlled clinical trials of the use of vitamin C to ameliorate or prevent the common cold. Young physician investigators designed and carried out these studies in 1973 and 1974 among children in two elementary boarding schools served by Public Health Service clinics on the Navajo Reservation. The investigators proceeded with a great deal of enthusiasm, but very little financial support. In the first study, they found that vitamin C supplements appeared to ameliorate upper respiratory symptoms and decrease total days of morbidity. In the second, larger study, the supplements were ineffective. Both programs generated great support among parents, children, and teachers in the Navajo communities. While the results of the first investigation were widely touted innational media, the negative findings that followed a year later were largely ignored.

Frankenstein, a story of scientific discovery turned to dread, with a lesson in ethics
Richard P. Holm, MD

Frankenstein, a novel written by a 19 year old Mary Shelley, truly represents a masterpiece work. In the early years of the 19th century, incredible discoveries in science were happening, coincident with remarkable societal reform and health care improvements. During this era, an enlightened young woman brought the essence of those movements together into a tragic horror story. This is the first novel of what would become the new category of “science fiction.”

Most notably, the story brings to scientists and physicians of any era, the ethical principle of nonmaleficence/patient safety, and the accountability that should come with all scientific advancement. A tragic novel of discovery, reform, and health care, Frankenstein gives the reader a unique and powerful grasp of the meaning of responsibility.

The sorcerer’s stone
David S. Goldfarb, MD

Uncertainty is a constant feature of clinical medicine. Patients often come to their own conclusions and strongly influence their physicians’ reasoning. But can physicians and patients reliably distinguish conventional therapy from placebo when uncertainty reigns? In this “Perspectives” piece, a patient with a history of kidney stones presents with discomfort that may or may not be related to a stone recurrence. Both the urologist’s technologic and shamanistic powers are invoked.

POETRY

Touching the Mimosa
Urias A. Almagro, MD

Reflection
Steven F. Isenberg, MD

Irritable Bowel
Myron F. Weiner, MD

Pediatrics Clinic
Sheryn Warren, MD

Presbycusis
David Goldblatt, MD