A Personal History of Nuclear Medicine

306 Pages·2006·7.43 MB·English

by  Henry N. Wagner Jr. MD, PhD (auth.)

A Personal History of Nuclear Medicine
Henry N. Wagner, Jr.
A Personal History of
Nuclear Medicine
Henry N. Wagner, Jr., MD, PhD
Professor of Environmental Health Sciences,
Johns Hopkins Bloomberg School of Public Health;
Professor Emeritus of Medicine and Radiology,
Johns Hopkins School of Medicine
Baltimore, MD, USA
A catalogue record for this book is available from the British Library.
Library of Congress Control
ISBN-10: 1-85233-972-1 eISBN: 1-84628-072-9
ISBN-13: 978-1-85233-972-2
Printed on acid-free paper.
© Springer-Verlag London Limited 2006
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To Anne, our four children, their spouses and nine grandchildren
for their never-ending love and help
Life-size portrait of Henry N. Wagner, Jr., MD, with two colleagues that now hangs in Hopkins Nuclear Medicine Division. Portrait by Cedric Egeli.
Foreword
Each year, at the annual meeting of the Society of Nuclear Medicine, Henry Wagner
summarizes his view of principal advances in the fi eld. In A Personal History of Nuclear
Medicine, he brings the same insight to the fi fty years he has practiced, preached and
breathed nuclear medicine. That same fi fty years spans the era in which radioactivity
has been harnessed to provide exquisite maps of physiologic function in the living
human body.
Thus, the book brings the perspective of an insider, whose own contributions have
been particularly infl uential: leader of a premier program in education and research;
founding member of the American Board of Nuclear Medicine; proponent of inter-
national cooperation and the World Congress, and much more.
Because of Henry’s positions and desire to meet and know colleagues throughout the
world (he and his wife Anne are most gracious hosts and visitors) this autobiography is
also a story of the major fi gures who grew the fi eld of nuclear medicine and made the
discipline into a coherent one.
The book also refl ects Henry’s personality: his candor and unfl inching way of
telling it the way he thinks it is, his punctuated use of aphorisms (some of his own
making), his deep understanding of who he is, and an innocent delight in many
accomplishments.
Some years ago, I suggested that Henry was a constructive troublemaker; someone
who goaded us out of accepted wisdom into new, and sometimes outrageous, thinking.
This volume documents his life, his philosophy, and his role in the coming of age for a
remarkable medical specialty.
S. James Adelstein
Chappaquiddick
July 2005
vii
Acknowledgment
I would like to acknowledge the inspiration and help of William G. Myers; the assistance
of Judy Buchanan and Anne Wagner for reviewing the manuscript; Hiroshi Ogawa for
his assistance, and Melissa Morton, Eva Senior and Robert Maged for their help.
viii
Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 1 Survival of the Luckiest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Chapter 2 So You Want To Be a Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Chapter 3 First Taste of Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Chapter 4 Medical School and House Staff Days . . . . . . . . . . . . . . . . . . . . . . . . . 46
Chapter 5 The National Institutes of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Chapter 6 A New Medical Specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Chapter 7 The Early Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Chapter 8 The Thyroid Paves The Way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Chapter 9 The Breakthrough to Lung Scanning . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Chapter 10 Computers in Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Chapter 11 From the Lungs to the Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Chapter 12 Growth Out of Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Chapter 13 Molecular Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Chapter 14 The Fight Against Infectious Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Chapter 15 A New Approach to Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Chapter 16 The Genetic Revolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
ix
Introduction
“There is a history in all men’s lives.”
—Shakespeare, Henry V
“The history of science is the history of scientists.”
—John Lukacs
“How can man perform that long journey who has not conceived whither he is
bound?”
—Henry David Thoreau
In September 2003, the National Institutes of Health (NIH) presented to the American
people the goals of the NIH for medical research in the 21st century. Dr. Elias Zerhouni,
who became director of the NIH in May 2002, had been Associate Dean for Research at
Johns Hopkins School of Medicine before going to the NIH as the fi rst radiologist
to head that agency. He had been trained in nuclear medicine while a resident in radiol-
ogy at Hopkins.
“Molecular imaging” was to be a major focus of research in the future of the NIH. This
declaration of intent by the NIH was exciting for those in nuclear medicine, because
molecular imaging had been the hallmark of nuclear medicine since its beginning.
The new NIH “Roadmap” focused on (1) the presymptomatic detection of disease; (2)
personalized treatment based on molecular targets; and (3) the discovery of the clinical
manifestations of genetic abnormalities. These had been the goals of nuclear medicine
for over half a century.
In 2002, a new institute of the National Institutes of Health, the National Institute of
Biomedical Imaging and Bioengineering (NIBIB), was created with an annual budget
approaching $300 million, adding to the imaging research being carried out in other
institutes, especially the National Cancer Institute. Imaging sciences had become a key
focus of today’s biomedical research, but this had not always been the case.
Those of us who had chosen to become specialists in nuclear medicine often encoun-
tered obstacles during the development of our careers. Many of the basic principles of
our new specialty had not yet achieved acceptance by the medical establishment. Anatomy,
radiology, and surgery remained the foundation of medical practice.
My fi rst encounter with nuclear medicine took place when I arrived in London in July
1957, fi ve years after I graduated from Johns Hopkins medical school. Nuclear medicine
was not then a recognized medical specialty. The general public had heard the term
1
2 A Personal History of Nuclear Medicine
Figure 1 Elias Zerhouni trained in nuclear
medicine at Johns Hopkins. At present, he is
head of the National Institutes of Health in
Bethesda, Maryland.
“atomic medicine” and associated it with the development of the atomic bomb. The fi eld
was based on the same scientifi c principles that had produced the atomic bomb. There
was in those days an underlying fear of anything that had to due with radiation. These
negative perceptions lingered long after the end of World War II. It would take decades
before nuclear medicine would fi nd its place in medical practice and biomedical research,
before nuclear medicine defi ned itself as a scientifi c and clinical discipline, and people
understood what the specialty was really all about. Nuclear medicine moved medicine
beyond its focus on anatomy to a new focus on “molecular medicine.” More than any
other specialty, it brought together structure and function. Arthur Koestler has written:
“In biology, what we call structures are slow processes of long duration; what we call
functions are fast processes of short duration.” They are both changes in mass as a func-
tion of time.
The story of the birth and growth of nuclear medicine is one of the most fascinating
in physics and medicine, an excellent example of the precept that things don’t happen;
people make things happen. Nuclear medicine evolved from using the tools of physics
and chemistry to solve patient problems. First, political, scientifi c, and technological
challenges had to be faced.
The “tracer” principle was invented in 1913 by Georg Hevesy. It refers to our ability to
“track” molecules as they participate in chemical processes. It is as if a molecule emitted
a radio signal telling us what it was doing at all times.
Hevesy was born in August 1885 in Budapest. Working with Fritz Paneth in Vienna,
he invented what he called “radioactive indicators.” After his chemistry experiments in
1913, in 1923 he carried out his fi rst radioisotope studies in biological systems, fi rst in
plants and then animals. In 1925, Herman Blumgart in Boston carried out the fi rst human
tracer studies by injecting his patients with solutions of the radioactive gas radon and
timing how long it took for the radioactivity to travel from the injection site in an arm
vein through the heart and lungs to reach the opposite arm.
In 1934, Hevesy left Berlin for political reasons and began to work in Copenhagen with
Niels Bohr, who had fi rst proposed the structure of the atom. In 1935, Hevesy began to
work with phosphorus-32, being provided the radionuclide through the mail from Ernest
Lawrence’s cyclotron in Berkeley, California.