WELLCOME WITNESSES TO TWENTIETH CENTURY MEDICINE _______________________________________________________________ TECHNOLOGY TRANSFER IN BRITAIN: THE CASE OF MONOCLONAL ANTIBODIES ______________________________________________ SELF AND NON-SELF: A HISTORY OF AUTOIMMUNITY ______________________ ENDOGENOUS OPIATES _____________________________________ THE COMMITTEE ON SAFETY OF DRUGS __________________________________ WITNESS SEMINAR TRANSCRIPTS EDITED BY: E M TANSEY P P CATTERALL D A CHRISTIE S V WILLHOFT L A REYNOLDS Volume One – April 1997 CONTENTS WHAT IS A WITNESS SEMINAR? i E M TANSEY TECHNOLOGY TRANSFER IN BRITAIN: THE CASE OF MONOCLONAL ANTIBODIES EDITORS: E M TANSEY AND P P CATTERALL TRANSCRIPT 1 INDEX 33 SELF AND NON-SELF: A HISTORY OF AUTOIMMUNITY EDITORS: E M TANSEY, S V WILLHOFT AND D A CHRISTIE TRANSCRIPT 35 INDEX 65 ENDOGENOUS OPIATES EDITORS: E M TANSEY AND D A CHRISTIE TRANSCRIPT 67 INDEX 100 THE COMMITTEE ON SAFETY OF DRUGS EDITORS: E M TANSEY AND L A REYNOLDS TRANSCRIPT 103 INDEX 133 WHAT IS A WITNESS SEMINAR? Advances in medical science and medical practice throughout the twentieth century, and especially after the Second World War, have proceeded at such a pace, and with such an intensity, that they provide new and genuine challenges to historians. Scientists and clinicians themselves frequently bemoan the rate at which published material proliferates in their disciplines, and the near impossibility of ‘keeping up with the literature’. Pity, then, the poor historian, trying to make sense of this mass of published data, scouring archives for unpublished accounts and illuminating details, and attempting throughout to comprehend, contextualize, reconstruct and convey to others the stories of the recent past and their significance. The extensive published record of modern medicine and medical science raises particular problems for historians: it is often presented in a piecemeal but formal fashion, sometimes seemingly designed to conceal rather than reveal the processes by which scientific medicine is conducted. As Sir Peter Medawar suggested, in his famous article, ‘Is the scientific paper a fraud’, much scientific literature ‘misrepresents the processes of thought that accompanied or gave rise to the work 1 that is described ...’, not deliberately intended to deceive, but structured and arranged in a rigid format that allows for little individual expression or amplification. Recourse to unpublished archives for elucidation can introduce additional difficulties. Official archives may have limitations on access: in the UK public records are subject to a restriction that keeps papers hidden for at least 30 years. Equally, specialist archives can present problems: the survival of personal papers can be erratic, many are lost during the lifetime of an individual, as space constraints or relocation demand the jettisoning of material without proper regard for its significance. Probably even more papers are wrongly discarded as worthless and uninteresting by their owners, or by relatives acting immediately after a 2 bereavement. Thus historians of contemporary medicine and science are increasingly turning, or returning, to the traditional technique of oral history to supplement, or 3 extend, existing records, and to create new resources. Recognizing that many of the principal sources of contemporary medical history are still walking around, although on increasingly elderly and fragile legs, they are attempting to hear, and record, their accounts. A particularly specialized form of oral history is the Witness Seminar, where several people associated with a particular set of circumstances or events are invited to meet together to discuss, debate, and even disagree about their reminiscences. Originally developed by the Institute of Contemporary British History (ICBH), this format attracted the attention of the History of Twentieth 1 Medawar P. (1990) Is the scientific paper a fraud? In Pyke D. (ed.), The Threat and the Glory: Reflections on Science and Scientists. Oxford: Oxford University Press, 228–233. 2 See Booth C C, Sheppard J G, Tansey E M. (1990) Archives of contemporary medicine and science. British Medical Journal 301: 1408. 3 See Tansey E M. (1995) Telling it like it was. New Scientist 148(2008): 49. i What is a Witness Seminar? Century Medicine Group, which was inaugurated by the Wellcome Trust in 1990, to bring together clinicians, scientists, historians and others interested in contemporary medical history. An initial experiment was to organize a meeting with the ICBH on the subject of ‘Monoclonal Antibodies’, which was held in September 1993. The response from those taking part or attending that meeting, and subsequent requests for the transcript, convinced the Steering Committee of the History of Twentieth Century Medicine Group that this forum should be developed. During the following summer a meeting on ‘Renal Transplantation’ was organized, and in the academic year 1994–1995 a number of smaller ‘mini’ Witness Seminars were included as part of the routine programme of the group. Since then Witness Seminars have become a regular feature of the Group’s activities, and subjects are usually proposed by, or through, members of the Steering Committee of the Group. From 1990–1995 this comprised Sir Christopher Booth (Chair), Dr Tilli Tansey (Secretary), Professor Bill Bynum and Dr Stephen Lock. They were joined in 1995 by Dr Lara Marks and Professor Tom Treasure, and in the following year by Dr David Gordon. Meetings already held or planned for the current academic year are listed opposite. Once a suitable subject has been agreed, we try to identify and invite participants, and to plan, in conjunction with the meeting’s chairman, a flexible outline plan for the progress of the meeting. Occasionally we have had to abandon or postpone meetings at this stage if key people are unable to attend. This is a constant problem when many we invite are elderly. Similarly, some meetings can be disrupted at the last minute by accidents or ill-health: sadly the late Professor Charles Fletcher suffered a bad and incapacitating fall just days before he was due to join Dr Philip D’Arcy Hart as one of the two principal witnesses at the ‘Pneumoconiosis’ meeting. Invitations inevitably lead to further contacts, further suggestions of people to invite, and we rely heavily on such recommendations. As the organization of the meeting progresses, we ask some participants to be principal witnesses; to speak for a short period of time to initiate and stimulate further discussion. Again, these arrangements differ from meeting to meeting, although all speakers are asked not to prepare formal presentations or to show slides, as these disrupt informal interchange. Thus by the time each meeting is held, it has already developed its own particular shape determined by the participants. For example, no one could dispute that ‘Endogenous Opiates’ would undoubtedly have been a different kind of seminar, not necessarily better or worse but different, if Hans Kosterlitz had been able to attend; or that ‘Monoclonal Antibodies’ would have been markedly different if the National Research Development Corporation had sent a representative who had been personally involved with the patenting issues that were raised. As each meeting proceeds it also develops its own kinetics, largely dependent on the personalities of the chairman and the participants, and the relationships among those taking part. No two meetings have ever been the same. Each meeting is fully recorded, and the tapes are transcribed. The Steering Committee then decides whether the transcript should be edited for publication. This decision is informed by two main factors – the overall coherence of the meeting, and whether the transcript will contribute new material to the published ii What is a Witness Seminar? History of Twentieth Century Medicine Witness Seminars, 1993–1997 1993 Monoclonal antibodies Organizers: Dr E M Tansey and Dr Peter Catterall 1994 The early history of renal transplantation Organizer: Dr Stephen Lock Pneumoconiosis of coal workers Organizer: Dr E M Tansey 1995 Self and non-self: a history of autoimmunity Organizers: Sir Christopher Booth and Dr E M Tansey Ashes to ashes: the history of smoking and health Organizers: Dr Stephen Lock and Dr E M Tansey Oral contraceptives Organizers: Dr Lara Marks and Dr E M Tansey Endogenous opiates Organizer: Dr E M Tansey 1996 Committee on Safety of Drugs Organizers: Dr Stephen Lock and Dr E M Tansey Making the body more transparent: the impact of nuclear magnetic resonance and magnetic resonance imaging Organizer: Sir Christopher Booth 1997 Research in General Practice Organizers: Dr Ian Tait and Dr E M Tansey Drugs in psychiatric practice Organizers: Dr E M Tansey and Dr David Healy The MRC Common Cold Unit Organizers: Dr David Tyrrell and Dr E M Tansey The first heart transplant in the UK Organizer: Professor Tom Treasure historical record. Of the meetings held so far, we decided not to publish the proceedings of ‘Renal Transplantation’ because many of the speakers repeated well known anecdotes and accounts, adding little fresh information or interpretation; ‘Pneumoconiosis’ was handicapped by the absence of Professor Fletcher; we have yet to come to a final decision about ‘Oral Contraceptives’. All other meetings will be published in this format, apart from ‘Ashes to Ashes’, which forms part of the proceedings of a symposium that will appear under that title in the Wellcome Institute’s History of Medicine Series published by Rodopi. iii What is a Witness Seminar? Once the decision has been taken to prepare a transcript for publication, a first editorial pass is simply tidying-up. Infelicities, the ‘ums’ and ‘ers’ are removed, and a copy then sent to all participants for them to correct, if necessary, their own contributions. Such amendments are principally stylistic, occasionally misremembered facts – names or dates – are corrected. When all these are returned, which can take several months, all the comments are usually incorporated into the master text. Extensive alterations, or the submission of fresh material, are confined to explanatory footnotes. At the same time, we begin to annotate the major reference points alluded to in the seminar, to add biographical and bibliographical details and to continue, if necessary, to edit the text. When this stage is completed the transcripts are again sent to every contributor, for his or her comments on the complete text. Once more, any subsequent comments, usually few, are incorporated if appropriate, or otherwise footnoted. Throughout we are keenly aware that our responsibilities are as editors, not censors, and that our aim is to make the substance of these meetings available to the informed non-expert. What then do Witness Seminars contribute to the historical record? At a fundamental level they can, and frequently do, serve to guide professional historians through the morass of published and archival sources already referred to, and to alert them to subject matter and sources of which they were unaware; conversely they emphasize to the scientists and clinicians taking part that ‘history’ embraces their working careers. This realization has a number of results – before, during and after meetings we are frequently given documents that are not preserved or accessible elsewhere, and in such instances we always suggest the proper conservation and archiving of the material. Perhaps understandably, it is the less well-known areas that have generated such responses, and many of our witnesses express astonishment at our interest! All such materials will, if not deposited elsewhere, be archived with the records of the meetings and eventually deposited in an appropriate archive for consultation by other scholars. There are also obvious disadvantages to this format. Primarily, the balance of participants is crucial, and there is little we can do if potential contributors are unable or unwilling to attend. Those who do attend may not contribute much, others may deafen with their axe-grinding. One check on the conduct and content of the meetings is the presence of other participants – a Witness Seminar can be seen as a form of open peer review, with all remarks and opinions immediately susceptible to rejoinder, agreement or dispute. Sometimes too, the frailty and variety of individual memory is all too clearly highlighted: an amusing but thought provoking illustration is provided by the differing accounts that emerged during and after the meeting of the ‘Committee on Safety of Drugs’ of the evolution of the yellow card for reporting adverse reactions. Acknowledgements Many people assist in the organization, recording and publication of these meetings. The contributions of Mrs Lois Reynolds and Dr Daphne Christie far exceed the editorial tasks that are acknowledged in the individual transcripts. They have jointly worked, as well as two people job-sharing one position can, on every document, standardizing, reformatting, and indexing the text. The attractive appearance of the finished product is almost entirely due to their efforts. They have been advised by staff of the Information Systems Department and the Publishing iv What is a Witness Seminar? Department of the Wellcome Trust, and we thank them for that assistance. Throughout, Mrs Wendy Kutner has helped organize and run all the meetings of the History of Twentieth Century Medicine Group, and I am enormously grateful to her. I would also like to thank the staff of the Wellcome Trust’s Audiovisual Department who are responsible for setting up and recording the meetings, Mrs Jaqui Carter our transcriber, and Mr Chris Carter for taking the photographs. I would particularly like to thank all those who have participated in our Witness Seminars, who have contributed so freely, corrected their drafts, and often provided additional material and memories. Finally, I gratefully acknowledge the Wellcome Trust for its financial support. Tilli Tansey Wellcome Institute for the History of Medicine v Technology Transfer in Britain: 1 The Case of Monoclonal Antibodies The transcript of a Witness Seminar held at the Wellcome Institute for the History of Medicine, London, on 24 September 1993 2 Edited by E M Tansey and P P Catterall 1 We are grateful to Frank Cass for permission to reprint this article, which has already appeared in (1995) Contemporary Record 9: 409–444. A paper on the discovery of monoclonal antibodies has appeared as Tansey E M, Catterall P P. (1994) Monoclonal Antibodies: A witness seminar on contemporary medical history. Medical History 38: 322–327. 2 Dr E M Tansey, Wellcome Institute for the History of Medicine; Dr P P Catterall, Institute of Contemporary British History. 1 Technology Transfer in Britain: The Case of Monoclonal Antibodies PARTICIPANTS: Dr Ita Askonas (London) Dr Basil Bard (London) Sir Christopher Booth (Chair) (London) Dr Robert Bud (London) Dr John Galloway (London) Sir James Gowans (Oxford) Sir John Gray (Cornwall) Dr Georges Köhler (Freiburg, Germany) Dr César Milstein (Cambridge) Mr John Newell (London) Dr David Owen (London) Dr David Secher (London) Dr David Tyrrell (Salisbury) Dr Guil Winchester (London) Professor Miles Weatherall (Charlbury) Dr Peter Williams (Oxford) 2 Monoclonal Antibodies In 1975 two Cambridge scientists published a short article in Nature which announced the discovery of monoclonal antibodies. The article concluded ‘Such cultures could be valuable for medical and industrial use’. The interest which developed by the end of the decade in the industrial and financial possibilities of the new prospects opening up in biotechnology was to throw the apparent ‘failure’ to follow-up the potentialities of this discovery into a public prominence rarely achieved by scientific discoveries. By the time Mrs Thatcher came to power it had become a scandal, another example of Britain’s apparent inability to exploit effectively the brilliance of its scientific base. It was to explore both the process of scientific discovery and the conditions in Cambridge which nurtured it, and the issues which this particular discovery raised in the area of technology transfer (and the changes of policy that ensued), that the Wellcome Trust’s History of Twentieth Century Medicine Group and the Institute of Contemporary British History organized this special witness seminar. It was held at the Wellcome Trust in London on 24 September 1993. The seminar was chaired by Sir Christopher Booth and introduced by Dr Robert Bud of the Science Museum. Those participating included the two authors of the Nature article, Dr César Milstein and Dr Georges Köhler, who received a Nobel Prize for their research, Dr Basil Bard (National Research Development Corporation (NRDC) 1950 to 1974), Sir James Gowans (Secretary of the Medical Research Council (MRC) 1977 to 1987), Sir John Gray (Secretary of the MRC 1968 to 1977), John Newell (BBC World Service science correspondent 1969 to 1979), Dr David Owen (MRC), and Dr David Secher (Laboratory of Molecular Biology (LMB), Cambridge). There were also contributions from Dr Ita Askonas (former head of immunology at the National Institute for Medical Research), Dr John Galloway (former member of MRC headquarters staff), Dr David Tyrrell (former Director, MRC Common Cold Unit), Professor Miles Weatherall (Head of Therapeutic Research Division, Wellcome Research Laboratories 1967 to 1975), Dr Guil Winchester (post- doctoral fellow, Wellcome Institute for the History of Medicine), and Dr Peter Williams (former Director of the Wellcome Trust). The organizers would like to thank the Wellcome Trust for hosting and sponsoring the seminar. We would like to dedicate this publication to the memory of Georges Köhler, who sadly died in April 1995 before this could appear. Dr Robert Bud: The study of contemporary history provides a rare opportunity for the active and self-conscious interaction of subject and viewer, which can be as daunting as it is exciting for the historian. Historians of the nineteenth century can rest assured that none of their subjects can say that it was not like that. At the same time it provides an opportunity for all of us to have a much more interesting interchange and identification of what are already understood to be momentous and important changes and developments. Already it is clear that the emergence of biotechnology as a whole is one of the big shifts in late twentieth century 3