Salient: Victoria University Students' Paper. Vol. 29, No. 6. 1966.
Medical research in New Zealand
Medical research in New Zealand
As A Medical Student develops into a doctor, he becomes aware of the limitations of medical knowledge. He meets patients with illnesses which cannot be diagnosed, are of unknown cause, have no effective treatment. If he becomes dissatisfied at his professional inadequacy, he may decide to devote part or all of his energies to medical research. To be successful at this he need neither be genius, nor know the sum of existing knowledge. If he has imagination together with the ability to think precisely and logically it is likely that he can make important contributions to medicine.
"Pure" and "applied" research.
In the Salient science supplement of 1965, the Hon. B. E. Talboys, Minister of Science, argues that in New Zealand we should have a greater emphasis on "applied" research and less on "pure" research. I sympathize with Mr. Talboys in his aim to make scientific research as efficient and productive as possible, but in my view Mr. Talboys has been badly avised as to the method of achieving this. The difficulty about research is that many problems are insoluble by direct frontal attack, no matter how much work is applied. This can and does lead to a great waste of money, as nothing is more useless than a research worker who is not discovering anything. No amount of agonising by doctors at the bedside led to the discovery of penicillin. Dr. Fleming was "aimlessly wandering" (to use Mr. Talboys' term) when he had the curiosity to make a study of the contamination of his bacterial cultures of a fungus.
One of the greatest skills of the successful professional research worker is the ability to select problems which are soluble and worth solving. Once he has started a fruitful line of research he knows how to let it lead him onwards, but he must know when to give up an avenue quickly and when to be persistent. Every now and then he makes an important advance, many of which have unforeseen applications. To make "applied" research as successful as possible in New Zealand, we must have plenty of "pure" research and we must retain our more able graduates by ensuring that there are adequate openings for them here. New Zealand is at the moment a scientific Cinderella and Mr. Talboys' policy is likely to make the situation worse. We should emulate our Australian cousins who are now paying full measure for their science and are reaping corresponding rewards, including the acquisition of many of our most able New Zealand graduates.
The need for medical research.
It is difficult for clinicians to think in the proper scientific manner, as apart from the emotional stresses to which we are subjected, we are constantly having to make decisions where the data are insufficient to warrant a decision. This gets us into bad thinking habits, of which we become unconscious. Research is the best corrective. All doctors who are so inclined should be able to participate in research. I believe it would be salutary if all post-graduate qualifications necessitated the writing of a thesis based on original work.
The establishment of the College of General Practitioners and the setting up of local research foundations are most beneficial developments. On the other hand, we need more full-time professional research units and the Medical Research Council's present annual expenditure of around £200,000 is hopelessly inadequate. The sum of £1,000.000 to £2,000.000. still paltry in relation to the cost of our clinical services, would be sufficient to enable the Medical Research Council to fulfil its proper function.
What is the aim of medical research? It is to provide everyone with good health for 70-80 years and at the end of this time, to ensure that death is merciful. The next hundred years is likely to bring us close to achieving this aim.
Some medical research achievements in New Zealand.
The Father of Medical Research" in New Zealand is Sir Charles Hercus, a man of wonderful vision, to whom New Zealanders owe much. When Sir Charles became Dean of the Otago University Medical School, the, national medical research output annually was a handful of case descriptions in the New Zealand Medical Journal. On Sir Charles's retirement the annual output was hundreds of papers, mostly published in the best overseas medical journals, describing original work of high quality. On his succession to the deanship, Sir Edward Sayers maintained the fine tradition of his predecessor by establishing the Wellcome Medical Research Institute, a great asset to medical research in New Zealand.
Iodine-deficiency goitre.
The first major medical research undertaken in New Zealand was a study of goitre, the name for enlargement of the thyroid gland, which is situated in the neck. This disorder, rare in Britain, became a major problem in New Zealand by the 1920s. Many people needed operative treatment and the incidence of defective babies was increasing. Other countries, notably Switzerland, were similarly afflicted. It had been suggested that a lack of iodine was the cause of the trouble, but evidence for this was inconclusive, largely because the amounts of iodine in food, water and soil are so low that they are difficult to measure. Hercus, Benson and Carter made an extensive study of the relationship between goitre incidence, iodine content of soil and water and geological structure.
Their findings encouraged the introduction of iodized salt as a preventive measure. One part of potassium iodide was added for every 200.000 parts of sodium chloride. This measure had considerable success in reducing the magnitude and incidence of goitres. In the 1930s Dr. H. D. Purves, using improved methods, was able to demonstrate that to be fully effective the iodide should be increased one part per 20.000 parts of salt. The implementation of this measure has virtually abolished iodine-deficiency goitre, but there is a danger of its recrudescence now that supermarkets throughout the country are selling pre-packaged non-iodized salt at a fraction of the price of iodized salt. Legislation is needed to prevent this unnecessary health hazard.
Endocrinology.
The thyroid gland is one of several small organs, called endocrine glands, which secrete into the bloodstream substances called "hormones." to regulate and integrate body processes. The study of these glands, endocrinology, has contributed much to therapeutics in the last few decades, including insulin, cortisone, contraceptive steroids, anti-thyroid drugs, a host of hormone preparations and a vastly improved understanding of many disease processes.
Having achieved the prevention of iodinedeficiency goitre, Dr. Purves and his colleagues Dr. W. E. Griesbach and Mr. T. H. Kennedy, turned their attentions to other endocrine problems. They brilliantly discovered the anti-thyroid drugs, which enable non-surgical treatment of toxic goitre. Purves and Griesbach then turned their attention to the pituitary gland, which controls most of the other endocrine glands by secreting into the blood seven master, or "trophic," hormones. A long-standing puzzle about the pituitary had been that it appeared to contain only three different types of cell and it was hard to understand how a single cell could produce several different hormones in appropriately varying amounts. Purves and Griesbach made themselves the world authorities in this difficult and important field by discovering five specific types of cell in the pituitary and establishing which hormone came from each.
Toxic goitre.
My own major research project has been a study of the causation of the disorder known as toxic goitre, or thyrotoxicosis, in which the thyroid gland is over-active, causing severe illness. For twenty years, men had been trying to establish whether or not the over-activity was caused by an excess of thyroid-stimulating hormone from the pituitary gland. With Dr. Purves's help, I set out to develop a method of measuring thyroid-stimulating hormone by its effect in guinea pigs treated with radio-active iodine. We hoped to use the method to determine whether patients with toxic goitre had abnormally high levels of thyroid-stimulating hormone in their blood. However, we found that blood from these patients had a thyroid-stimulating action which was qualitatively different from that of the thyroid-stimulating hormone.
This observation was the discovery of what is now known as "long-acting thyroid stimulator (LATS)." Subsequent work has indicated that the presence of LATS in the patient's blood is the cause of toxic goitre and that LATS is an "auto-antibody." LATS is the only example so far discovered of an auto-antibody which stimulates a body process, all previous examples having only destructive or blocking effects. Agents analogous to LATS, yet to be discovered, are likely to play important roles in other autoimmune diseases.
Arteriosclerosis.
The major cause of death in New Zealand is obstruction or rupture of arteries consequent upon a disorder known as arteriosclerosis. This disorder of arteries is related to high blood pressure. Sir Horace Smirk is the great authority amongst those who attempt to reduce the incidence of "vascular accidents" by using drugs to lower high blood pressure. This is a field in which even slight progress brings quick returns in reduction of human suffering.
Virology.
Now that antibiotics and chemotherapeullc agents give us such excellent control of most bacterial infections, viruses are becoming relatively more important. There is no effective treatment for viral infections and viruses are much more difficult to detect than are bacteria. Viruses are probably the major cause of minor illness in our community and also cause serious illnesses such as infectious hepatitis. They may also be implicated in auto-immune disorders and in cancer. In my view research in this field should be increased, especially as in Professor J. A. R. Miles, New Zealand possesses one of the world's best virologists. The establishment of virus diagnostic laboratories in New Zealand is an important advance. The discovery overseas of an anti-viral substance, "interferon," which is made by animals, gives hope for the development of a virus penicillin. More rapid identification of viruses and production of vaccines will also lead to reduction in illness due to these insidious agents.
Auto-immunity.
To defend himself against microbial parasites, man has evolved an immunity mechanism. For complete effectiveness, this mechanism must be able to produce a specific antibody to fit and destroy any one of millions of different types of potential invaders. However, no antibody must be produced which will react with and damage man's own tissues.
Apparently these two requirements are too difficult to be met with complete success. Some people are unable to defend themselves against a particular infection and others make antibodies which cause auto-immune diseases by reacting with body tissues.
The list of possible auto-immune diseases includes: rheumatoid arthritis, lupus erythaematosis, glomerulonephritis, rheumatic fever, some forms of diabetes, disseminated sclerosis, some forms of anaemia, ulcerative colitis, myasthenia gravis toxic goitre, myxodema.
The existence of auto-immune disorden was first suspected only 10 years ago. Dr. Marianne Bielschowsky greatly facilitated the study of this problem by breeding [ unclear: mic] which suffered from auto-immune anaemil and lupus erythaematosis. Using these mice Dr. B. J. Helyer and Dr. J. B. Howie are making leading contributions to the fulle understanding of auto-immunity.
Surgery.
If organs such as kidneys, livers, hearts and lungs could be transplanted from one person to another, the benefits would be immense The obstacle to be overcome is the so-called "homograft reaction" in which the immunity mechanism makes antibodies which destroy the transplanted organ. Professor M. F. A. Woodruff initiated research on this important problem in Dunedin. It is being continued with exciting prospects of ultimate succest by Dr. Barbara Heslop.
In Auckland, Mr. Barratt-Boyes has achieved justified fame by demonstrating that transplanted human heart valves are superior to valves made of artificial material, in the surgical correction of a valvular defect.
Genetics.
One of the most important discoveries ever made in biology is that of the chemical nature of replicating molecules, DNA, which are the basis of life. These molecules contain the genetic code for each living individual, determining all inherited characteristics. Eventually the exact composition of each gene will be known, with exciting therapeutic possibilfties. For instance, there is a miserable condition known as cystic fibrosis where a genetic defect causes respiratory difficuitler through production of mucus of wrong viscosity. It may be possible, one day, to blow into the lungs of such people, episomes, containing the portion of DNA needed by the mucous cells to enable them to manufacture the enzyme whose lack causes the mucus to be defective. Much biochemical research will be needed to bring dreams such as this to fruition.
Dr. A. M. Veale has initiated research into human genetics in New Zealand. Dr. J. Loutit and Dr. Sheila Howarth-Thompson are doing exciting work making use of bacteria, which particularly lend themselves to genetic experiments. Dr. John Read, who studies the effect of radiation on living cells, is an outstanding contributor to this very important field.
Basic Medical Sciences.
The foundations of medical research lie in the departments of anatomy, biochemistry and physiology. New Zealand has been particularly fortunate in having Professors W. E. Adams. N. L. Edson and J. R. Robinson to head these departments at the Otago Medical School. These three men are most accomplished research workers and have made distinguished contributions to their fields.
This is of necessity an illustrative rather than a comprehensive account of medical research in New Zealand, but mention must be made of the outstanding work of Dr. Muriel Bell in nutrition and of Dr. F. Bielschowsky in cancer research.
The Future.
No one can foresee all the developments ahead. It is certain, however, that computers will eventually take over hospital case records and will play a major role in diagnosis, with enormous increase in clinical efficiency and in research output.
If advances in biochemistry and genetics enable us to gain control of the immunity mechanism, it may become possible not only to eliminate auto-immune diseases, but also to destroy cancers by inducing the formation of appropriate antibodies.
We are on the threshold of great wonders.