You bet your life : from blood transfusions to mass vaccination, the long and risky history of medical innovation

You bet your life From blood transfusions to mass vaccination, the long and risky history of medical innovation

Paul A. Offit

Book - 2021

"Four months into the coronavirus pandemic, as the death count surged, the FDA made a risky decision: it approved an anti-malarial drug as a treatment for coronavirus, despite limited data on its efficacy or side effects. A month later, the FDA withdrew its recommendation, but by then, the damage had been done. The drug was ineffective and sometimes even lethal. The mistake was hardly a one-off. As virologist Paul. A. Offit shows in You Bet Your Life, from antibiotics and vaccines to x-rays and genetic engineering, risk, and our understanding of it, have shaped the course of modern medicine, paving the way for its greatest triumphs and tragedies. By telling the stories of the events--and of the frequent hypocrisy and cravenness of the ...characters at their center--Offit shows how risk, and failure, have driven innovation, and importantly, how by examining our mistakes we can make better medical predictions and decisions going forward. From the outlandish origins of blood transfusions, which began with humans receiving blood for barnyard animals, to the the disastrous debut of the first polio vaccine, and the backstabbing and infighting that surrounded early gene therapies, he captures the drama that surrounds medical research, the way ego and laziness can collide with science, and ultimately how those factors should inform what we choose to do and have done to us in the clinic. The history is fascinating in its own right, but the worldwide rush to create a coronavirus vaccine only makes learning from the lessons of history essential. Weighing the uncertainties of a treatment against its potential benefits is one of medicine's greatest ethical dilemmas, and Offit examines it from every angle. He explores not just how patients and their families respond to risk but how everyone from physicians and researchers to universities and regulators do, too, and how that ultimately determines what treatments are put forward. Not everyone has the same goal. And too often the patient's health is secondary. But as Offit shows, we can all minimize risk and failure by learning how to recognize conflicts of interest, to draw inferences from animal models, and to evaluate risk, even when we have limited data. Along the way, Offit asks who should decide what risks are acceptable, and who should pay when the results are fatal. In the end, however, Offit argues that we are gambling whatever we do--and that we need to take that seriously, whether we pursue a treatment or decide to do nothing at all. The answers aren't simple, and the outcomes are life or death. Examining these questions with the compassion of a pediatrician and the rigor of a scientist, Offit reminds us that we all have a role to play in ensuring that medicine upholds its very first principle: to do no harm"--

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Subjects
Therapeutics > History.
Therapeutics > Complications.
Diffusion of innovations.
Medicine > Research > History.
Biotechnology > Risk assessment.
Bioethics.
Published
New York : Basic Books 2021.
Language
English
Main Author
Paul A. Offit (author)
Edition
First edition
Physical Description
258 pages ; 25 cm
Bibliography
Includes bibliographical references (pages 223-240) and index.
ISBN
9781541620391
  • Introduction You Bet Your Life
  • Part I. Risk
  • Chapter 1. Louis Washkansky: Heart Transplants
  • Chapter 2. Ryan White: Blood Transfusions
  • Chapter 3. Hannah Greener: Anesthesia
  • Part II. Oversight
  • Chapter 4. "Jim": Biologicals
  • Chapter 5. Joan Marlar: Antibiotics
  • Chapter 6. Anne Gottsdanker: Vaccines
  • Chapter 7. Clarence Dally: X-Rays
  • Part III. Serendipity
  • Chapter 8. Eleven Unnamed Children: Chemotherapy
  • Chapter 9. Jesse Gelsinger: Gene Therapy
  • Epilogue Living with Uncertainty
  • Acknowledgments
  • References
  • Index
Review by Publisher's Weekly Review

Offit (Overkill), director of the Vaccine Education Center at the Children's Hospital of Philadelphia, explores nine major medical advances in this impressive look at history and technology. "Virtually every medical breakthrough has exacted a human price," he writes, and aims to prove that no medical innovations are risk-free. The nine advances he focuses on--transplants, blood transfusions, anesthesia, biologics, antibiotics, vaccines, X-rays, chemotherapy, and genetic engineering--have all "been accompanied by tragedy," and a look back at these lessons, he argues, can prevent them from being repeated. Offit first covers transplants, outlining how, in the mid-1960s, dozens of people died in attempted animal-to-human heart transplants, and early blood transfusions were similarly dangerous up until the 1900s, when blood typing began. All the men involved in early anesthesia trials "met unfortunate ends," and public opinion of biologicals was tainted when a tainted tetanus antiserum killed patients. The way Offit tells the story of each medical advance is fascinating, packed with case studies and characters, including groundbreaking scientists and near-death patients. Ultimately, Offit writes, there's risk associated with all new developments--"We can't wait until we know everything, because we never know everything." This thorough survey is as entertaining as it is informative. (Sept.)

(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review

Offit is an American pediatrician, a nationally renowned virology and immunology expert, and a prolific consumer health book author (Overkill: When Modern Medicine Goes Too Far). His new title comes in the wake of the COVID-19 pandemic, during which Offit has served on the FDA's vaccination advisory committee and on a similar committee for the NIH. He reflects on the highly unusual and unique factors in the development of fast-tracked COVID-19 vaccines, which he contextualizes with nine historical medical advances. He describes the earliest research and experiments with vaccination (starting in the late 1800s) and addresses racial and disability injustice in both historical and modern medicine. In an epilogue titled "Living with Uncertainty," Offit highlights seven themes that affect current vaccine decisions, regarding the level of risk individuals and society are willing to undertake to make medical progress. He acknowledges the existence of uncertainty and the risks required for the work of medical explorers of the modern age, along with the near inevitability of such risk. Offit illustrates his points with relevant examples from the development of COVID-19 vaccines. VERDICT A well-written and informative look at the reality of medical advancement, including poignant examples of its often-fatal repercussions.--Elizabeth J. Eastwood, Los Alamos, NM

(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review

How the medical advances we take for granted came to be--and it's not a pretty picture. Offit, a professor of pediatrics and vaccinology, specializes in denouncing bad doctors and popular health nonsense. In his latest, he switches gears and follows the history of medical innovation. Though we are "at the dawn of a wondrous age," he writes, there's a "catch…virtually every medical breakthrough has exacted a human price." He illustrates with gripping, often gruesome stories of the early years of lifesaving treatments plus other medical stories that are merely horrific. In 1967, South African surgeon Christiaan Barnard became a worldwide celebrity by transplanting the first human heart. Surgeons around the world rushed to follow suit, with terrible results. In 1968, only 10% of recipients lived for two years, a number that worsened the following year; by 1971, most hospitals had closed their transplant units. The story ends happily as more judicious surgeons refined their techniques, and heart transplants are now as routine as bypass surgery. Offit then chronicles other medical success stories with rough beginnings--e.g., a 1920 professional gathering of radiologists 20 years after X-rays became an essential medical tool: "So many attendees were missing hands and fingers that when the chicken dinner was served no one could cut their meat." Every child with acute lymphoblastic leukemia died before the first treatment appeared in 1947. Most improved with the first chemotherapy but "eventually relapsed and died." Today, drugs cure 90% of those cases, but many tragedies happened along the way. Offit also tells the sad story of Ryan White, a hemophiliac who, in 1984, was infected with AIDS via a blood transfusion. Although doctors agreed that no one could catch his disease, ignorant neighbors and school officials treated him heartlessly. Certainly, the maxim that no one should know how sausages are made applies here, but Offit is a fluid storyteller armed with decades of knowledge, and he provides an educative, though often distressing, reading experience. Unsettling but realistic medical histories. Copyright (c) Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

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