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Tuesday, 28.03.2017

Reply (Blackwell)


Both Paul Grof and Gordon Johnson express surprise and, perhaps, muted disapproval for how I interpreted Sam Gershon’s comments on his involvement in the very early stages of the lithium story and the manner in which John Cade dealt with this twenty years later. Only Sam can clarify his concerns and motivations but I was struck by his comment as a young and enthusiastic investigator that, “Nothing was easy when you had the whole psychiatric establishment against you.”

This exchange allows me to clarify my views on what may be an important difference between a personal and historical perspective on such matters. When Frank Ayd and I planned the 1970 Baltimore Conference we were united in our educational and historical goal of garnering first-person accounts from the early pioneers but our perspective differed. Frank knew each of them personally while, as a 36 year old newcomer to America, I had met none of them.

My task was not to discuss them as individuals but to present an opening commentary on “The Process of Discovery.”  To do this I undertook an exhaustive search of the literature and related that body of knowledge to my own experience involving the MAOI and cheese interaction. I was particularly influenced (and still am) by the lifetime body of information from Robert Merton concerning the behavior of scientists in discovery. This was also a humbling experience; I recognized my personal behavior was called into question. My original Lancet article failed to mention that a hospital pharmacist had alerted me to the cheese possibility in a letter describing two episodes that occurred with his wife. Over the course of two years pharmacology research and several publications I failed to give credit to the drug company representative who had encouraged me to pursue the interaction. I remedied these oversights in two ways – I quoted and credited the pharmacist in every clinical account I published thereafter and I wrote and published an article describing the drug representatives role with his name as first author.

With this as background let me dissect Cade’s behavior in more detail and explain why I consider it worthy of analysis. Twenty years after his original report of lithium’s beneficial effect in severe mania the widely held view of how lithium gained such a significant role in the treatment of bipolar disorder might be metaphorically likened to a three legged stool. Lithium’s reputation was based on Cade’s original finding, Schou’s extrapolation of that to prophylaxis and Trautner’s work in converting a toxic and potentially fatal ion into a safe therapeutic tool.

Trautner was an Australian immigrant, working in the same city and academic setting as Cade. Cade’s capacity to lift the ban he had appropriately placed on lithium’s use must have been enabled as soon as he learned of his colleague’s findings (perhaps abetted by Sam Gershon, a resident in Cade’s program). In making his presentation at the Baltimore Conference it is difficult to imagine how Cade could selectively credit Schou with lithium’s success and not mention Trautner.  Without Trautner Cade’s discovery might have been only a footnote in history, not a headline. That I chose to invoke cryptomnesia as an alibi might be considered a generous avoidance of the alternative.

There is an innate human tendency, to embellish one’s own accomplishments, the obverse of modesty. At this moment one of America’s leading news anchors is under scrutiny for exaggerating his bravery and the dangers faced while reporting in a war zone. Anyone who has read Tolstoy’s War and Peace will know that this is a common, perhaps universal, trait. The battles generals describe they won often look nothing like the events historians uncover.

INHN, by it very title, is an historical website and while personal anecdotes play an important role (I manage the biography program) we should beware of idealistic or even idolatrous portrayals that distort reality or deny credit where it belongs, particularly to young investigators whose futures lie ahead. Certainly Sam’s distinguished career indicates he was not harmed. But someone less talented or dedicated might have become discouraged. Cade and Schou are well remembered names, Trautner less so. Is that just or historically accurate? Does casting light on Cade’s understandable and forgivable behavior in this single event seriously tarnish his well established reputation?

Barry Blackwell

April 2, 2015