The Case of Monoclonal Antibodies; Self and Non-Self

143 Pages·1999·0.54 MB·English

by  The Wellcome Trust

W W
ELLCOME ITNESSES TO
T C M
WENTIETH ENTURY EDICINE
_______________________________________________________________
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
©The Trustee of the Wellcome Trust, London, 1997
First published by the Wellcome Trust, 1997
Occasional Publication no. 4, 1997
The Wellcome Trust is a registered charity, no. 210183.
ISBN 978 186983 579 8

P lease cite as : Tansey E M, Catterall P P, Christie D A, Willhoft S V, Reynolds L A. (eds) (1997)
W ellcome Witnesses to Twentieth Century Medicine, vol. 1. London: The Wellcome Trust.

Key
Front cover photographs, L to R:
Monoclonal Antibodies: Dr Georges Köhler (1946–95), Sir Christopher Booth, Dr César Milstein (1927–2002)
Endogenous Opiates: Dr Derek Smyth
Endogenous Opiates: Professor John Hughes

Back cover photographs, L to R:
Self and Non-Self: Professor Peter Campbell, Professor Richard Batchelor, Sir Christopher Booth
Committee on Safety of Drugs: Dr Tilli Tansey, Dr Stephen Lock, Mr Wilfred Turner,
Professor Owen Wade (1921–2008)
Committee on Safety of Drugs: Dr Josephine Weatherall, Professor Miles Weatherall, Professor David Finney
Self and Non-Self: Professor Deborah Doniach (1912–2004), Professor Ivan Roitt
Endogenous Opiates: Professor Lesley Rees, Professor Howard Morris
C
ONTENTS
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
that is described ...’,1 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
bereavement.2
Thus historians of contemporary medicine and science are increasingly
turning, or returning, to the traditional technique of oral history to supplement, or
extend, existing records, and to create new resources.3 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.
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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
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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
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