Nobel Prize Winner Sir James W. Black (1924-2010)

Whether you know it or not, you have benefited greatly by the work of this man who passed away this week.

It is extraordinary to create a new drug that is the first of its kind; Sir James W. Black, MD did it not once but twice. If you have ever taken a beta-blocker (like atenolol, propranolol, or carvedilol) or an over-the-counter heartburn remedy (such as Zantac or Pepcid) you are indebted to Dr. Black. If you have never required either class of drugs, you still owe a great deal of gratitude to this scientist.

I have interviewed several Nobel Prize winners through the years, with the first being Dr. Black. What a place to start! His work helped take medicine to a new place that continues to produce life-saving drugs.


A Whole New World
Early drug development was based on chemical modification of natural substances. For example, early Greeks used willow bark as a fever fighter. Today we know it as aspirin. Another mainstay of medicine came from a beautiful country garden flower called foxglove; in 1775, an old woman’s home cure was first recognized as containing a powerful heart medication called digitalis.

Sir James W. Black, MD was one of the pioneers who introduced a more rational approach to drug development based on understanding basic biochemical and physiological processes. Instead of synthesizing drugs from naturally-occurring compounds, Dr. Black and others looked to purposefully build drug molecules that would directly interact with cells and cellular processes throughout the body.

Here’s just one example of how this works. Epinephrine and norepinephrine have opposing effects in the body. In 1948, American scientist Dr. Raymond Ahlqvist suggested these opposing effects were mediated by different receptors in the target organs. He called these different receptors alpha- and beta-receptors, suggesting that substances could selectively stimulate these receptors (agonists) or inhibit these receptors (antagonists). It was this theory that inspired Dr. Black and his colleagues.


A Nobel Life
Like many Nobel Laureates, Dr. Black’s personal story was colorful. In describing his education, this Scottish doctor admitted he “coasted, daydreaming, through most of my school years.” At 15, a math teacher “more or less man-handled me into sitting the competitive entrance examination for St Andrews University.” The fourth of five children from a staunch Baptist family, there was no money to send another kid to university, but that did not matter when his test scores led him to a full scholarship.

After earning his doctorate, he decided against a career as a medical practitioner due to what he perceived as the insensitive treatment of patients at the time. (To understand just how uninspiring medicine was back then, read my posting on the $14 Billion Heart Attack here: http://bit.ly/5PEh2j.) Instead, he joined the University of Glasgow in their veterinary school, eventually establishing the school’s physiology department.

He developed an interest in the way adrenaline affects the human heart, particularly those suffering from the often crippling chest pain known as angina. He had a theory to annul the effects of adrenaline, so he joined ICI Pharmaceuticals in 1958, where he created the first beta-blocker, propranolol. The discovery of this drug was hailed as the greatest breakthrough in the treatment of heart disease since the discovery of digitalis two centuries earlier.

He saw that the general idea might be applied to treat stomach ulcers, but his employers weren’t interested. So, Dr. Black left ICI in 1964 and joined Smith, Kline and French. (After numerous acquisitions and mergers, the company is known today as GlaxoSmithKline.) There, in 1975, he developed cimetidine (sold as Tagamet) which became the best-selling drug in the world. The drug that Tagamet knocked out of the #1 slot for worldwide sales: propranolol.

Based on this pivotal research, Dr. Black shared the 1988 Nobel Prize in Physiology or Medicine with Gertrude B. Elion and George H. Hitchings for their discoveries of “important principles in drug treatment.”

Of all the things Dr. Black and I discussed 10 years ago, this stands out:

He met his wife, Hilary, when they were both students at St. Andrews University. Upon graduation, Dr. Black stayed there as a teacher while his wife completed her degree in biochemistry. Dr. Black called his wife “the best student I ever had.” Her eclectic pursuit of knowledge led her to study law and later poetry.

Calling her "the mainspring of my life" until she died in 1986, he said, “Intellectually, she was the most exciting person I have ever known.”

Dr. Black, many could say the same about you.

2001: A Medical Odyssey

How Did Experts Do in Predicting What Medicine Would Look Like Today?

In 1987, 227 world-class scientists were asked to predict the state of medicine in the 21st Century. This was no simple survey: the full report was 203 pages of statistics and analysis, commissioned by Bristol-Myers and conducted by Louis Harris and Associates,

When I originally wrote about the predictions, my work was front-page news in medical and lay news outlets. Now, the future is here: how did the experts do?

• They predicted a 67% cancer cure rate: Pretty much right on target. Today, the 5-year survival rate for cancer overall is 66%. (The comparable cure rate when the experts made their prediction: 54%.)

• No more heart bypass: Missed it by a mile. Specifically, cardiovascular scientists predicted most of the 230,000 heart bypass surgeries being done in 1987 would be replaced by less invasive procedures. Well, there are now 1.3 million such minimally invasive heart interventions done each year; but far from being replaced, nearly twice as many heart bypass procedures are being done each year in the US today (448,000) compared to 1987. It’s partly a factor of an aging population, but mostly it’s a realization that specific types of patients still do better with open surgery.

• 61% predicted an AIDS vaccine by the year 2000: Way too optimistic. Later this year, experts will gather for the 10th annual AIDS Vaccine Conference. In their preliminary program, the chairs of the conference state that despite “encouraging progress…we remain a long way from an affordable, effective vaccine against HIV.”

• A majority predicted an AIDS cure by 2010. Nope. (To be fair, 73% of the infectious disease experts surveyed in 1987 were at complete odds with most of the other experts and saw little or no improvement in treating AIDS by 2000.)

• The death of traditional psychoanalysis. Saw this one coming and, not surprisingly, the central nervous system experts who predicted this were way over-confident. (The word cocky also comes to mind.) Granted, the percentage of patients who receive psychotherapy is about 28.9% today compared to 44.4% in 1996-97. Still, that’s far from “little or no role” for psychotherapy. Importantly, there’s one big reason for the downturn in psychotherapy: financial incentives (insurance reimbursement) favor short medication visits compared with longer psychotherapy sessions. However, given growing concern regarding the widespread use of psychotropic drugs coupled with recent research showing the benefits of cognitive therapy, reports of the death of psychotherapy are greatly exaggerated.

• The “Golden Age of Biology.” Dr. Leroy Hood, whose work revolutionized genetic engineering and biology, said, “I think we will develop every bit as revolutionary technologies in the next 10 years as we have in the past 10 years.” Frankly, if the survey were repeated today, I suspect many of our current world-class scientists would agree and say the same thing about the next 10 years in medicine.

Finally, the experts in 1987 were nearly unanimous on one point: that disease-prevention would do more than advances in either treatment or diagnosis. For example, while steady improvement was predicted for “curing cancer,” there was almost complete agreement that a smokeless society would be the most effective strategy in the prevention and treatment of lung cancer.

25 Years Ago, Kids Were Fitness Failures; It 's Only Gotten Worse

Overwhelming Evidence Heart Disease Starts in Childhood

In September 1985, I wrote: “In the middle of a wellness boom, our children’s fitness is a bust.” Twenty-five years ago, in an age of 10K runs, aerobic fitness centers, and Jane Fonda workout videos, our kids were physical wrecks. Since then, things have deteriorated to a point where some might think of the 1980s as “the good ol’ days.”

Today’s kids may be the first generation to have a shorter lifespan than their parents, but parents can stop the obesity epidemic. http://bit.ly/17KfEK Here are some ideas and links to more information.

• Getting young kids to eat better is not as hard as you think. That’s because the biggest influence on their eating habits is mom and dad. As I explained some time ago, if you want your kids to eat better – especially younger kids – then buy better foods. http://bit.ly/7rDkdd Just today, I reminded a friend who wants to lose weight that the easiest way to avoid junk food is to not buy it!

• Consider the French Paradox. Research scientists have been puzzling for years over why the French eat more fat than Americans yet have a lower incidence of heart disease and a much thinner population. This explains a lot: there is a huge difference between what French and American children eat for lunch at their schools. Similarly, there is a big difference in what French and US parents teach kids about food. http://bit.ly/d4emHj

• Are kids fat because we’ve taken the fun out of fitness? Experts think there is too much focus on sports and not enough on just moving. http://bit.ly/8N59ne It doesn’t take a lot. For almost 2 years now my youngest son and I have walked about half an hour every day. It’s great fun for us and both of us have lost weight.

• Studies conducted over the last several decades provide overwhelming evidence that heart disease often starts in childhood. Fortunately, even without weight loss, kids who exercise show a big reduction in markers associated with a greater risk of heart disease. http://bit.ly/570QzE

• Do you eat when stressed? Guess what: Kids often have the same response. Sadly, many parents are blissfully unaware just how stressed out their kids are today. http://bit.ly/4EhLDH And, frankly, all work and no play makes kids more than dull; it’s why they're so anxious and depressed. http://bit.ly/6Tx829

• If kids have a weight problem, it’s a family problem. You won’t have a lot of authority if you tell your child he needs to lose weight when you’ve just opened a sack of potato chips. Think extended family, too: Youngsters are more apt to be fat with regular grandparent care. http://bit.ly/bDdCZT Clearly, grandma and grandpa need to up their babysitting game.

This isn’t rocket science, although you might think so given our complete failure at addressing these issues. It requires paying attention, avoiding mixed messages, and making better nutrition and more activity priorities.

Killer Salt has been Given More than a Fair Shake

Food Giant Knew It was Using Weak Research to Confuse the Public

People who should know better are warning of the coming war on salt. They are deriding efforts to curb our consumption of this vital but wildly overused mineral.

The source of their “war” propaganda was a recent paper in the New England Journal of Medicine. The authors estimated that cutting daily salt intake by 3 grams (less than a teaspoon), would dramatically improve health in the United States, including a huge impact on stroke and heart disease deaths. http://bit.ly/4sh1xu Indeed, if we could curb our salt habit, experts say we would prevent about half a million strokes, another 500,000 heart attacks, and save some $32.1 billion in medical costs over the lifetime of adults ages 40 to 85. http://bit.ly/ausqjY

So, what’s the confusion? In a word: marketing.

Earlier in my career, a bright Oregon scientist claimed to have discovered that a lack of calcium and not an excess of sodium was linked to hypertension. I know this because I covered the story for many of the consumer and physician publications I worked for at the time.

Shortly thereafter, another scientist who had an insider’s point of view let me know I had been duped. (Me and a thousand other reporters.) Turned out I was talking with a researcher whose office had funded the study, much to his dismay. The doctor who did the calcium research had turned to one of the largest manufacturers of salty snack foods for investigational support (money). In an interoffice memo, the corporate director of research and development questioned the investigator’s “weak” results, but recommended funding his work.

Why? He stated that the data would confuse the public and “release the pressure on sodium for the time being.” Moreover, he noted that the controversy over salt would return, but the study would provide a break from the nonstop negative press being given to high-sodium-content foods. The memo even went so far as to suggest that since the researcher’s scientific credentials were weak the company should provide him “with scientific assistance to enhance his credibility and promote visibility.” (Note: his emphasis, not mine.)

The memo also suggested releasing the data during a time when most leading heart doctors in the U.S. would be out of the country attending an international cardiology meeting. The memo noted that this would give the calcium story several days of media attention before any medical authority could get caught up with the news and caution against the findings of the calcium study.

I am not naming the researcher since I doubt he was privy to the in-house intrigue that was the determining factor behind his funding. But I offer this as a cautionary tale. We saw this once before with the tobacco industry doing everything in its power to support really bad science that very effectively confused the public. Clearly, some within the food industry were taking notes.