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The Phoenix Phenomenon in medical research

Ilene Rushn
Editor
29 September 2008

The "Phoenix Phenomenon" has been presented as a concept about ideas in science and medicine that although presented as original concepts, had been proposed in the past and then rejected and forgotten, until later arising like the mythical bird from their own ashes. In an article in Pharos, Allen B. Weisse, MD, a retired professor of Medicine at the New Jersey Medical School, applies the term to cases where an investigator suffers a devastating event - the loss of data, the inability to reproduce results, or severe illness - yet moves on to achieve the final goal. A few of his examples follow.

Struggling to Repeat Results: James Collip and Insulin

At the end of 1921, Canadian surgeon Frederick Banting and his medical student assistant Charles H. Best were working under Professor J. J. R. MacLeod at the University of Toronto, attempting to isolate and purify insulin from beef pancreas for the treatment of diabetes. Since these two lacked the biochemical expertise needed to succeed in this attempt, MacLeod assigned Collip, a young physiologist and biochemist, to assist them. Collip had already established himself as a skillful and resourceful individual in his field and was rapidly advancing through the academic ranks. Collip did not disappoint them. In about a month he succeeded in purifying the insulin obtained from the beef pancreas extracts. Soon after, with the cooperation of Connaught Laboratories in Toronto, the team planned to mass produce the hormone to meet the urgent requests of clinicians throughout Canada and the United States who had learned of their efforts. Just as production was about to begin, Collip found that he could no longer produce the purified insulin that had been the result of his earlier efforts. Somehow or other he had simply lost the knack. Collip, under severe pressure, frantically persisted in trying to reproduce his earlier results with multiple methodological variations. After several more weeks of effort, he succeeded, and the rest, as they say, is (medical) history. In 1923 the Nobel Prize in Medicine or Physiology was awarded to Banting and MacLeod, and a major brouhaha ensued. Banting publicly challenged the decision by giving half of his reward money to Best. MacLeod responded in kind with a similar gesture to Collip. Whatever the controversy surrounding the full extent of Collip's role in the affair, he became a major figure in Canadian science, often being looked upon as the father of Canadian endocrinology.

Barriers to Success: Charles P. Bailey and John W. Kirklin and Open Heart Surgery

Following multiple unsuccessful attempts in the 1920s by Elliott Carr Cutler, Samuel A. Levine, and Claude S. Beck, the field remained fallow until the 1940s when surgeons at four separate sites felt justified in returning to the problem. Dwight E. Harken at Harvard, Russell C. Brock at Guy's Hospital in London, and Horace G. Smithy at the Medical College of South Carolina in Charleston were all, to a great extent, insulated from outside disapproval and pressures by the august institutions with which they were affiliated. In contrast, Charles
P. Bailey (1910–1993), a flamboyant and free wheeling New Jersey surgeon, proved a more accessible target for his detractors. As he moved ahead with his surgical approach to open up the mitral commisures, unsuccessful operations caused him to become increasingly isolated and at risk for losing all of his operating privileges at the hospitals to which he had been affiliated. What kept him going? Perhaps it was the memory of his own father coughing up blood in the final throes of his losing battle against mitral stenosis? Bailey wrote:
"Finally, however, you have to face the “moment of truth” and the poignancy is so great that I can't really express it. You know that almost all the world is against it; you know that you have a great personal stake and might even lose your medical license or at least your hospital privileges if you persist. In fact, the thought crosses your mind that maybe you really are crazy. And yet you feel that it has to be done and it must be right." In the 1950s and 1960s, following John H. Gibbon, Jr.'s, initial success on closing an atrial septal defect using his heart-lung machine in 1953, further scattered individual attempts with heart-lung machines to correct congenital cardiac defects showed no clear evidence of efficacy. John W. Kirklin (1917 - 2004) at the Mayo Clinic performed a series of such procedures using a modification of Gibbon's apparatus. Of eight patients, four died. Despite the high mortality this was considered an indication of success rather than failure, and open heart surgery was on its way.

Overcoming Illness: Sherwin B. Nuland

Loss of mental or physical integrity can also represent a catastrophic event for a physician. Early in his career as a surgeon and, later, as a medical writer and historian, Sherwin B. Nuland (1930) suffered a depression so severe that it required his admission to a mental hospital. No medications or psychotherapy seemed to have any effects and lobotomy was being considered. Finally, electroshock therapy was attempted, and proved effective. Despite a few minor recurrences of the depression a remarkably productive career has followed.

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