“You can’t imagine how much things have improved in a generation,” Josef reflected as we came to the end of our tour. “It’s the most satisfying thing in the world to know that most of these children will be cured and can go home and resume their lives. But wouldn’t it be even more wonderful if they didn’t have to come here in the first place? That’s the dream.”
*1 Originally “cancer” described any non-healing sore, from which it is related to “canker.” In its more specific modern sense, it dates from the sixteenth century. The word comes from the Latin for “crab” (which is why the celestial constellation and its associated zodiac sign are called Cancer). It is said that Hippocrates, the Greek physician, used the term for tumors because their shape reminded him of crabs.
*2 The alert reader will note that all these percentages taken together add up to more than 100 percent. That’s partly because they are estimates—in some cases little more than guesses—and come from different sources, and partly because of double or triple counting. A retired coal miner’s fatal lung cancer could, for instance, be attributed to his working environment or the fact that he had smoked for forty years, or both. More often than not, the cause of a cancer is anyone’s guess.
22 MEDICINE GOOD AND BAD
Doctor: What did you operate on Jones for?
Surgeon: A hundred pounds.
Doctor: No, I mean what had he got?
Surgeon: A hundred pounds.
—PUNCH CARTOON, 1925
I SHOULD LIKE to say a word about Albert Schatz, for if ever there was a man who deserved a moment’s grateful attention, it is he. Schatz, who lived from 1920 to 2005, was from a poor farming family in Connecticut. He studied soil biology at Rutgers University in New Jersey not because he had a passion for soil but because, as a Jew, he was subject to university admission quotas and he couldn’t get into a better institution. He reasoned that whatever he learned about soil fertility would at least be useful back on the family farm.
It was an unfairness that ended up saving lives, for in 1943, still a student, Schatz followed a hunch that soil microbes might provide an additional antibiotic to put alongside the new drug penicillin, which, for all its value, didn’t work against bacteria of a type known as Gram-negative. This included the microbe responsible for tuberculosis. Schatz patiently tested hundreds of samples and in just under a year came up with streptomycin, the first drug to vanquish Gram-negative bacteria. It was one of the most important microbiological breakthroughs of the twentieth century.*
Schatz’s supervisor, Selman Waksman, immediately saw the potential of Schatz’s discovery. He took charge of the clinical trials of the drug and, in the process, had Schatz sign an agreement ceding patent rights to Rutgers. Soon afterward, Schatz discovered that Waksman was taking full credit for the discovery and keeping Schatz from being invited to meetings and conferences where he would have received praise and attention. With the passage of time, Schatz also discovered that Waksman had not relinquished patent rights himself, but was pocketing a generous share of profits, which were soon running into millions of dollars a year.
Unable to get any satisfaction, Schatz eventually sued Waksman and Rutgers, and won. In settlement, he was given a portion of the royalties and credit as co-discoverer, but the lawsuit ruined him: it was considered very bad form to sue a superior in academia in those days. For many years, the only work Schatz could find was at a small agricultural college in Pennsylvania. His papers were repeatedly rejected by leading journals. When he wrote an account of the discovery of streptomycin as it had really happened, the only publication he could find that would accept it was the Pakistan Dental Review.
In 1952, in one of the supreme injustices of modern science, Selman Waksman was awarded the Nobel Prize in Physiology or Medicine. Albert Schatz received nothing. Waksman continued to take the credit for the discovery for the rest of his life. He didn’t mention Schatz in his Nobel acceptance speech or in his 1958 autobiography, in which he merely noted in passing that he had been assisted in his discovery by a graduate student. When Waksman died in 1973, he was described in many obituaries as “the father of antibiotics,” which he most assuredly was not.
Twenty years after Waksman’s death, the American Society for Microbiology made a somewhat belated attempt at amends by inviting Schatz to address the society on the occasion of the fiftieth anniversary of streptomycin’s discovery. In recognition of his achievements, and presumably without giving the matter a lot of thought, it bestowed on him its highest award: the Selman A. Waksman medal. Life sometimes really is very unfair.
If there is a hopeful moral to the story, it is that medical science progresses anyway. Thanks to thousands and thousands of mostly unsung heroes like Albert Schatz, our armory against assaults of nature has grown stronger and stronger with every passing generation—a fact happily reflected in dramatically improved life spans across the planet.
By one reckoning, life expectancy on Earth improved by as much in the twentieth century as in the whole of the preceding eight thousand years. The average life span for an American male went from 46 years in 1900 to 74 by century’s end. For American women, the improvement was better still—from 48 to 80. Elsewhere, the improvements have been little short of breathtaking. A woman born in Singapore today can expect to live for 87.6 years, more than double what her great-grandmother could have counted on. Across the planet as a whole, life expectancy grew from 48.1 years for men in 1950 (which is as far back as global records reliably go) to 70.5 today; for women the rise was from 52.9 to 75.6 years. In more than two dozen countries, life expectancy today is over 80 years. At the top is Hong Kong at 84.3 years, closely followed by Japan at 83.8 and Italy at 83.5. The United Kingdom does quite well at 81.6 years, while the United States, for reasons that will be discussed below, comes in at a decidedly mediocre life expectancy of 78.6 years. Globally, however, the story is one of success, with most countries, even in the developing world, recording improvements of 40 to 60 percent in life spans in just a generation or two.
Nor do we die as we used to. Consider the lists below of principal causes of death in 1900 and now. (The accompanying numbers indicate deaths per 100,000 of population in each category.)
The most striking difference between the two eras is that nearly half of deaths in 1900 were from infectious diseases compared with just 3 percent now. Tuberculosis and diphtheria have disappeared from the modern top ten but been replaced by Alzheimer’s and diabetes. Accidents as a cause of death have jumped from seventh place to fifth, not because we have grown clumsier, but because other causes have been eliminated from the top tier. In the same way, heart disease in 1900 killed 137.4 people per 100,000 per year, while today it kills 192.9 per 100,000, a 40 percent increase, but that’s almost entirely because other things used to kill people first. The same goes for cancer.