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A Personal History of Nuclear Medicine PDF

306 Pages·2006·7.43 MB·English
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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 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or trans- mitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. Printed in Singapore (BS/KYO) 9 8 7 6 5 4 3 2 1 Springer Science+Business Media springer.com 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.

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