"In 1900, the era of scientific medicine is only just beginning." "There are few first-rate physicians almostnes." "If you become sick or injured you'll need a strong constitution or plenty of luck to survive even if you are president of the United States." "It's been a few decades since the French scientist Louis pasteur discovered the microscopic creatures we call bacteria and demonstrated that these germs could cause many illnesses." "Later, researchers discover an even tinier infectious agent-- the virus." "But despite these discoveries many people continue to blame sickness of human traits and social conditions--riety a poor constitution, a degenerate lifestyle or miasmic clouds of filth emanating from the city slums." "Though the scientific community knows that germs cause disease they don't completely understand how they're spread and they certainly don't know how to destroy them." "In the early morning hours of June 27, 1899 a ship sails into San Francisco bay ending a fateful voyage from Hong Kong." "At the U.S. quarantine station on angel island a delegation of health officials anxiously awaits the ship's arrival." "Two passengers aboard may have died from the dreaded bubonic plague." "If it's true, the ship cannot be allowed to reach the mainland." "Angel island is San Francisco's bastion of defense against infectious diseases." "All immigrants must first pass through these hallways to be examined and disinfected." "Anyone who shows signs of illness could be quarantined or sent back home." "Lately, health inspectors have been especially worried that foreigners might bring in the plague an ancient aeadly bacterial infection that rapidly overwhelms the body's defenses." "Man:" "There was a great deal of fear and anticipation in San Francisco that the plague was going to invade the west coast." "In fact, the plague had already begun in China 30 years earlier and had moved down the coast to cities like canton and Hong Kong with which we had a great deal of commercial traffic as well as immigration traffic." "Osgood:" "There are hundreds of thousands of victims in China and India." "Japan, the Philippines and Hawaii havek." "When the plague breaks out in the Chinese quarter of Honolulu panicked officials accidentally burn the neighborhood to the ground." "500 years after the plague wiped out a third of Europe in the middle ages there is still no cure." "And now the disease may have finally reached America." "At angel island, the ship is quarantined by the U.S. government's top bacteriologist, Joseph kinyoun." "Assuming that plague bacteria is spread person to person kinyoun quarantines the mostly Asian passengers and crew." "Ike his colleagues I he also believes plague bacteria thrive in dirt and can be spread to human dwellings by vermin." "So he orders the ship fumigated with steam and poisonous sulfuric sprays." "As officers inspect the cargo stowaways are suddenly discovered." "Two appear to have the plague." "Fearing imprisonment the ill stowaways escape during the night and try to swim to San Francisco." "Early the next morning their corpses are found floating in the harbor." "When local officials announce that they do have the plague the city feels more vulnerable than ever." "(Trolleys dinging, horns honking)" "On march 6, 1900, the Chinese year of the rat the body of chic gin, a Chinese merchant is found in the basement of a cheap hotel." "An autopsy confirms everyone's worst fears-- the plague has struck in Chinatown." "Accusing the Chinese of being foul spreaders of disease the city jumps into action." "Policemen string a heavy rope around the 15 square blocks of Chinatown." "To their surprise, Chinese San franciscans discover they are now prisoners to their surprise, chinesin their own homes.Iscover guards are assigned to keep residents from spreading the disease to the white community." "Armed with crowbars and disinfectants posses systematically raid and fumigate every house destroying the worst of the slums." "Anyone who even looks sick is whisked away to angel island." "Man:" "The Chinese response to what was happening was terror." "What would they be subjected to?" "Uld they be put?" "What would they be subjected to?" "Would a wall be placed around Chinatown?" "Would they all be expelled from the United States?" "Risse:" "And when the posse of policemen with a few volunteers were coming into the various houses with crowbars and axes and started to tear down walls and doors the hostility and the panic increased dramatically." "Osgood:" "The Chinese smuggled their sick out of the city through a vast labyrinth of tunnels beneath Chinatown." "Many ee on rafts floated out into the bay." "As a result no one knows how many plague victims there really are." "But with fewer than 200 confirmed deaths relieved authorities declare the quarantine a success." "(Bell ringing)" "Life returns to normal." "The memory of the plague recedes with the years." "Few realize that the city is more vulnerable than ever." "(Low rumbling)" "(People screaming, bell tolling)" "In 1906, a devastating earthquake rocks San Francisco." "Aging fires spread in 1906, a devastating earthqthroughout the city.Isco.R more than a thousand people die." "Rats, disoriented by the earthquake swarm through the streets and the plague strikes again." "But this time, there is no talk of quarantining neighborhoods." "Public health officials now target rats instead of people." "Rats had always been associated with plague outbreaks but now scientists understand their role in transmitting the disease." "Researchers in India noticed that plague-ridden rats and human victims were both covered with flea bites." "When they found plague bacteria in the saliva of fleas the connection was made." "Fleas were biting diseased rats and then transmitting the plague bacteria when they bit humans." "The city bands together to wage a war on rats and fleas." "Buildings are rat-proofed and fumigated." "Garbage is collected and removed." "Over a million rats are trapped and slaughtered." "As a result a disease that could have reached epidemic proportions is stopped in its tracks." "Kraut:" "When the 1907 epidemic finally petered out" "San franciscans could look back and discover a few things." "One is a better understanding of medicine of scientific medicine had led to the extermination of rats and a hunt for rats rather than people as compared to 1900." "But certainly bacteriology was becoming increasingly important." "Germ theory had led to a whole new scientific u?" "Erstanding of what makes people sick." "Osgood:" "Epidemic diseases like typhoid and cholera begin to fade as cities start providing safe drinking water and better sewer systems." "Reducing diseases like yellow fever." "And educational campaigns teach mothers how to better feed and nurture their children." "As a result, infant mortality begins to decline." "And by the second decade of the century life expectancy in western countries starts to rise." "Now public health tried to be proactive rather than reactive." "They tried to prevent things from happening rather than reacting after they happened." "This was also the progressive era in American history and this was a time when the progressives were very interested in reforms of all kinds." "They had a great faith in science." "Science was the new religion." "And this reformist spirit atacted a number of very good, young physicians who wanted to make public health a career." "Osgood:" "One of the most influential public health figures of the period is Joseph goldberger." "In 1914, he's summoned by the surgeon general to investigate an especially bafflingly disease ravaging the American south." "It's called pellagra." "The victims develop reddish, rough skin that often appears as a butterfly-shaped rash." "As the disease progresses patients become confused, hallucinate and finally go insane." "There have been tens of thousands of deaths in the rural south by the time Joseph goldberger is assigned the case." "Woman:" "At the time it was a mystery disease and pey theories about what caused it." "The most prominent theory was that it was caused by eating corn." "And there were other people who thought that it must be carried by an insect." "This was fairly early on in the bacteriological revolution and so some people thought that it was carried by a bacteria but no one knew what caused it, and there was great panic." "Osgood:" "Goldberger journeys through the south to ove firsthand the conditions where pellagra is most severe." "Everywhere he travels, the picture is strikingly similar-- working in cotton fields and textile mills suffering from the disease." "Goldberger visits insane asylums e institutions where alarming numbers of new cases are being reported." "He knows the disease causes insanity which might account for the victims in asylums." "But why is it so prevalent in orphanages and prisons?" "And if it's an infectious disease why isn't the staff getting sick as well?" "Kraut:" "One would think that if this were a germ disease the germs certainly wouldn't be aware of status boundaries." "Why would only the inmates get pellagra and why never a nurse, a physician or a teacher?" "And he began to look at what people ate and he was horrified at what he saw because the diet was so miserable-- not like anything he had ever seen before." "It was the diet of the Southern frontier consisting primarily of cornbread and so increasingly as he went from institution to institution, uh, observing goldberger became convinced that he was dealing with some sort of nutritional issue, but not a germ disease." "Osgood:" "Goldberger is well aware of the recent discoveries of chemical elements in food called "vitamins."" "He also knows that diseases like scurvy and beriberi have been linked to vitamin deficiencies and he suspects pellagra may be the same kind of disease." "Goldberger decides to test his theory at two orphanages full of pellagra victims in Jackson, Mississippi." "With fresh vegetables, meat and mi foods rich in vitamins and proteins." "Kraut:" "And lo and behold, much to his own delight the children who had pellagra got well when their diets were changed and those who didn't have pellagra didn't contract pellagra after their diets were changed." "Well, that was all well and good but it certainly wasn't scientific evidence and goldberger was very much aware of that." "Osgood:" "Goldberger publishes his diet theory anyway." "If he's right, lives will be saved and if he's wrong, better food certainly won't harm anyone." "But to his dismay, few take his theory seriously." "Etheridge:" "A lot of people didn't believe Dr. goldberger's theory because the medical profession was just getting used to the bacteriological revolution and they could not believe that they had something yet that they..." "Hing else that they had sthat they had to master.." "Met they could not get used to the fact that a disease could be caused by the lack of something." "It's like proving a negative and they just couldn't h that." "Some of them may have taken offense also at the fact that his criticism of the diet implied a criticism of the Southern way of life." "Osgood:" "Goldberger decides to show southerners that he can actually give people pellagra by simply changing their diet." "He persuades the governor of Mississippi to pardon any convicts who volunteer for a controlled diet experiment." "He chooses the ranking prison farm because there ra and plenty of room to isolate the convicts from germs." "The volunteers whose offenses range from embezzlement to murder are dubbed "the pellagra squad."" "Etheridge:" "They were moved to a special building that had screens on the windows so that no insects could come in." "It was scrubbed once a week very carefully." "They wore clean clothes every day." "The only thing that was different about their lives other than that was the food that they ate." "Instead of eating the vegetables from the prison garden what they're now going to be eating is what other impoverished southerners eat-- cornbread, cornmeal, corn mush, occasionally some pork." "In short, he's going to switch their diet in such a way that it will be the diet that he has observed pellagra victims eating" "osgood:" "At first, the men treat the experiment as a lark." "It all seems so easy." "But three weeks in, they start complaining to goldberger." "They are nauseated." "They suffer pains in their backs and sides." "They become moody, confused and exhausted." "Two men beg to be released saying they would prefer a lifetime of hard labor to another week of this "hellish experiment."" "Six month later, seven of the 11 prisoners break out with the characteristic pellagra rash." "Kraut:" "Goldberger is thrilled." "He has succeeded at what he wants to do and he expects everyone not only to applaud his efforts but to accept his understanding of pellagra that this is a dietary disorder and not a germ disease." "Osgood:" "Goldberger tells the pardoned men which foods they should eat to cure their pellagra and then waits for public acknowledgment of his breakthrough." "But acceptance doesn't come." "Some southerners even accuse him of perpetrating a hoax." "When he links pellagra to jobs that don't pay enough for people to eat well southerners hear only his social criticism not his medical reasoning." "Goldberger, the scientist, is stunned by what he sees as total irrationality." "Brieger:" "The goldberger story shows you that science by itself is not enough that people have to change their behavior people have to believe what the scientists are telling them and only then will they actually act upon the knowledge that someone like goldberger provides." "Osgood:" "Goldberger returns to the lab and dedicates the rest of his life to finding the specific cause of a disease he already knows how to prevent and cure." "He hasn't found the answer when death comes atge of 53 from another mystery disease, cancer." "He died a disappointed man because pellagra was more prevalent in 1929 than it had been in years and he thought that he was a failure." "Osgood:" "Eight years after goldberger's death scientists finally discover that niacin, a b-complex vitamin can prevent the disease." "It's soon added to common foods." "Today there are no more cases of pellagra in the United States and hardly anyone knows this terrible disease ever existed." "By 1920, there has been a revolution in public health." "We have strategies that can help to prevent infectious diseases and we understand that better food, cleaner water and improved sanitation can lead to a longer and healthier life." "Of course, people still get sick a lot and when they do, they have mostly these to turn to." "Here is Cooper's new discovery for indigestion, rheumatism for blood disease, fever and chills, male and female problems and if that isn't enough, it also removes worms." "The busy Cooper medical company also offers" "Cooper's quick relief which claims to cure everything from toothache to cholera." "And let's not forget glycoheroin for coughs-- one-half grain of pure heroin in every fluid ounce." "But there are signs that things are about to change." "Using x-rays and laboratory tests science is carefully studying the body now." "Beginning to understand science is carefully our internal organs, our glandse sbeginning to understand science is carefully our intcalled "hormones" glandsr ate so muchto understand science is carefully our of our inner chemistry.Regul but how we can use this knowledge" "to help those whose bodies have broken down that's another matter entirely and as always, time is running short." "Osgood:" "Of all the ways our bodies can betray us few are as terrifying as diabetes." "The disease strikes some when they are young others when they grow old." "All who suffer are consumed with a terrible hunger and thirst but no amount of food or drink will help." "The diabetic's body cannot absorb what it takes in." "Slowly, the victim slips into a deadly coma that doctors are powerless to halt." "No one can explain this breakdown of the body's internal chemistry but it's reasoned that if diabetics cannot tolerate food perhaps they can survive by eating less." "The leading proponent of this theory is Dr. Frederick Allen an uncompromising man who demands that his patients lose at least 30% of their body weight." "Man:" "Dr. Allen's undernutrition approach-- promptly dubbed "the starvation approach to diabetes"-- led to a ghastly kind of therapy in which people who were already complaining that they couldn't get enough food and drink had to do with less" "and, in fact, had to gradually starve to death." "And there are terrible stories of diabetic patients stealing hot food from ovens burning their hands to do it eating toothpaste and birdseed left in their rooms." "But if you starved yourself carefully you could buy another year or two of life but it was not a very satisfactory life." "Osgood:" "Only the strong-willed can survive the Allen diet." "Elizabeth Hughes the 11-year-old daughter of a supreme court justice has already lost 20 pounds." "Barely clinging to life" "Elizabeth and her parents can only pray for a scientific breakthrough to save her." "A glimmer of hope comes when researchers discover that a gland in the abdomen, called the pancreas plays an important role in the disease." "The gland appears to have two major functions." "It produces enzymes that travel through ducts and into the small intestine to help in the digestion of food and it produces another internal secretion that is absorb into the bloodstream to help regulate the metabolism of sugars and other carbohydrates." "Because diabetics have a high level of sugar in their blood scientists wonder if their disease is being triggered by the gland's failure to produce this internal secretion." "Almost immediately, attempts are made to isolate this substance in hopes of curing the disease but by 1920, no one has succeeded." "Then a young Canadian surgeon named Frederick banting stumbles across an article about the relationship between diabetes and the pancreas which gives him an idea." "He goes to Toronto university and meets with an internationally known expert on the metabolism of carbohydrates, j.J. Macleod." "Although banting has no background for this type of research he proposes a new approach to the problem." "Banting's idea is to tie off the pancreatic ducts leading to the small intestine so the cells making the digestive juices will atrophy and die." "Then only the pancreas's "internal" secretion will be actively produced, making it easier to isolate." "Intrigued, macleod agrees to give banting ten dogs to experiment on a tiny lab the services of a research assistant, Charles best and a few mont on the problem." "The eager young scientists begin operating on the dogs with disastrous results." "Bliss:" "You have to imagine working in a laboratory in sweltering weather without air conditioning." "Imagine a couple of enthusiastic young researchers trying to operate on dogs the sweat pouring off their bodies dripping into the wounds of the dogs..." "The dogs becoming infected and dying at a faster rate than they ever dreamed of that they were killing so many dogs that they went out on the streets of Toronto and bought extra dogs and slipped them into the lab surreptitiously." "Almost everything that could go wrong did go wrong." "There were times when they were ready to quit." "Osgood:" "Finally, after weeks of fumbling banting and best manage to make an extract they hope will contain the internal secretion." "They inject it into the dogs whose pancreases have been removed and who are now severely diabetic." "It will be hours before the researchers will know if the injection has lowered the dogs' high level of blood sugar." "When they measure the level again it's gone down dramatically a sign that the extract is working." "The pair is convinced it's a breakthrough." "An ecstatic banting awaits macleod's return from his summer holiday to share the results and ask for additional support." "He wanted better facilities." "He wanted more dogs, more assistants." "He also wanted some money because he was working for nothing and was broke." "Um... wanted his research to have the highest priority in j.J.R. Macleod's lab." "Macleod was not prepared to do this because the results were not yet at anything like that level of credibility." "So banting and macleod, at the end of the summer of 1921 had a terrible confrontation with banting finally saying to macleod:" ""Dr. macleod, we will see" ""if the university of Toronto appreciates the importance of my research."" "Macleod saying, "Dr. banting, as far as you are concerned iam the university of Toronto."" "Best remembered banting coming out of the meeting frothing best remembered banting coming at the moutheetinglly saying, "I'll show the little son of a bitch that he isnot the university of Toronto."" ":" "That he isnot the macleod wants to know."Good how long a diabetic dog can survive on banting's extract-- to see if it's effective over time." "But to carry out the new experiment banting and best will need far more of the internal secretion than they presently have." "In a desperate move, banting grinds up pancreases obtained from the local slaughterhouse and tries to isolate the internal secretion by cooling and separating it with alcohol solvents." "Surprisingly, this simple method gives him the supply of extracts he needs." "The exhausting months of tying off pancreatic ducts have been totally unnecessary." "The researchers are now ready to begin the longevity experiment with diabetic dog 27 and dog 33." "Both animals are given two daily injections." "11 days later, dog 27 goes into shock and dies." "Instead of prolonging the dog's life the extract has mysteriously killed it." "But dog 33 is alive and well even after 70 days of injections." "Theorizing that dog 27 was killed by impure extract macleod suggests bringing biochemist j.B. Collip onto the team." "The experienced collip quickly improves the quality of the extract." "He writes in his diary:" ""We have obtained from the pancreas of animals sterious something "we have obtained from the pancreas of animals"a my" ""which when injected into totally diabetic dogs" ""completely removes all the cardinal symptoms of the disease."" ""If the substance works on humans it will be a great boon to medicine."" "Collip's "mysterious something"" "is the internal secretion of the pancreas-- a hormone that the team names "Insulin."" "On January 11, without collip's knowledge banting prepares his own version of the extract." "It will be given to a 14-year-old diabetic boy named leonar." "Banting hopes the injection will lower the boy's high level of blood sugar." "But when it fails to work and causes a reaction the experiment is halted." "Bliss:" "What a discouragement." "What a discouragement." "The extract had always been loaded with toxic contaminants and even on the dogs, the effect had been very erratic." "Sometimes you had good stuff, sometimes it didn't work." "It was just so full of impurities that it was really a kind of hit-and-miss, scatter-gun approach-- maybe hitting a few more times than missing but in fact it missed in the first clinical test." "Osgood:" "On January 23, Leonard Thompson is given a new extract, prepared by collip." "This time it works." "The boy becomes more alert, looks better and says he feels stronger." "It's the first successful use of Insulin on a human diabetic." "Amazingly, sadly the great breakthrough on Leonard Thompson was followed by the utter breakdown of relat of the research team as collip went to banting and best in the lab and said" ""I've done it, I know how to do it."" "Banting said, "how did you do it?"" "Collip said, "I'm not going to tell you."" "Whereupon banting grabbed collip and tried to throttle him." "It was close to a fist fight in the lab." "How could this happen?" "How could researchers on the brink of a great discovery like this-- a discovery that really is of global importance-- how could they turn into wrestling children?" "Somebody had talked about patenting the discovery and as often in science teamwork, co is all very good until immortality, glory and dollars start to intrude." "Osgood:" "After the breakthrough with Leonard Thompson collip is put in charge of making the extract in larger quantities." "But this time, his new methods fail." "He goes back to his old laboratory procedures and they don't work either." "He had blended and filtered, concentrated and diluted distilled and evaporated never making the same batch of extract twice and now he has trouble recalling what he has done." "As the first store of Insulin runs out the team is besieged by dying patients." "They put aside their differences and work together in the lab." "Three months and countless combinations later they regain the ability to make Insulin but still only in small quantities." "Desperate for help, they forge an alliance with Eli Lilly a large American pharmaceutical firm." "Lilly's chemists soon solve the problems of mass production." "Finally there is enough Insulin for everyone." "The impact on diabetics is immediate and extraordinary." "One doctor, stunned by the resurrection of his patients evokes the biblical story of Ezekiel:" ""I will bring flesh upon you, put breath in you and you shall live."" "He calls it "banting's chapter of the Bible."" "The first child banting brings back from a deadly coma is Elsie needham." "Four months later, she seems like a healthy, normal girl with years of life ahead of her." "Yet of all banting's grateful patients his most memorable is Elizabeth Hughes who had barely clung to life." ""You'd think it was a fairy tale," she writes her mother." ""I look entirely different" ""gaining every hour in strength and weight." "Oh, it is simply too wonderfulfor words!"" "In Boston, Dr. Elliott joslin is one of the first American specialists to be supplied with Insulin." "He endorses it as one of the greatest discoveries of the century-- the beginning of a new epoch in medicine." "But eventually, he and his staff realize that the drug is not as miraculous as they had hoped." "Man:" "In the beginning, after the discovery of Insulin its use was widely misunderstood." "Everyone thought this was a cure, and why not?" "Of course what was not known was that people were alive, but not necessarily cured." "It was not until..." "Oh, the 1940s there was a great age of disillusionment because they then discovered that although the people lived and lived really normal lives they were developing eye complications kidney complications, nerve complications." "Simply to give Insulin was not good enough." "It had to be precisely the right amount such as your body does in normal circumstances." "Osgood:" "Joslin is among the first to realize that Insulin has transformed diabetes from a fatal disease to a chronic one." "He warns that the era of coma and death has given way to the era of complications." "He teaches his patients that the disease can only be held at bay by strict diet, constant testing and a rigid schedule of injections." "But there's no mistaking the elation that although diabetes cannot be cured it can at least be tam." "Brieger:" "The effect of Insulin was to show in a very dramatic way that doctors really could be effective that they could treat a dreadful disease in a relatively simple and inexpensive way and that science now really made a difference." "And this gave not just doctors more confidence in what they were doing but it gave patients a greater confidence in what medicine could do for them and it immeasurably boosted the image of medicine in the eyes of the public." "By now, when a doctor comes to your house-- yes, there are such things as house calls-- he comes with a few real remedies in his leather case." "Besides Insulin for diabetics he has aspirin for aches, pains and fever..." "Digitalis for a bad heart..." "And for infectious disease he at least has a vaccine that can prevent smallx." "Now, a vaccine does not cure you of anything." "It actually gives you a weakened dose of the disease." "But your body is now able to protect you against the real illness should you come in contact with it later on." "But the elusive prize for medical science is to find something that can cure people after they've gotten sick." "Since the days of pasteur, researchers have searched for substances that could kill bacteria-- the germs that cause infections ranging from pneumonia to blood poisoning all of which can be life-threatening." "But no one has found tcine"" "even after decades of trying." "Osgood:" "One laboratory scientist searching for weapons against bacteria is British researcher Alexander Fleming." "He's just beginning his career when the outbreak of war allows him to observe firsthand severely infected wounds." "Man:" "When the first world war broke out" "Alexander Fleming, like many other physicians found himself over in northern Europe treating battlefield casualties." "The fields in northern Europe, in Belgium, flanders-- these were richly fertilized fields and richly fertilized fields are rich in micro-organisms which, when they come in contact with exposed wounds cause deadly infections." "It's said that probably more soldiers died from infection than died from direct bullet or shell injury." "Osgood:" "On the battlefield, Fleming experiments with various antiseptics and even manages to save severa" "after the war, he returns to england for compounds that can kill bacteria." "Sneader:" "Fleming went off at the end of July every year for summer holidays in the north of Scotland, and July 1928 was no exception." "He tidied up his laboratory before leaving, of course and in doing so, he took all the plates that he'd been growing bacteria on and he stacked them in a bath of antiseptic." "But there wasn't enough antiseptic in that bath to cover all the plates." "Fortunately, one or two remained uncovered." "Osgood:" "What happens next is the stuff of legend recreated in a film by Fleming himself." "Newsreel announcer:" "Here at St. Mary's hospitaling ton through this very window 25 years ago a speck of mold blew in and settled onto professor Fleming's culture plate." "Sneader:" "Many people will tell you that the mold came in from the street through the window of Fleming's laboratory." "Fleming couldn't possibly have opened his window he had a whole bench Fleming couldn't possibly full of laboratory glasswarese and petri dishes in front of him and he couldn't have stretched over to open the window." "No truth in that story." "The mold almost certainly came from the laboratory below his where a researcher was working with fungi and that mold landed on the dish at the top of the stack, and started to grow." "Osgood:" "Weeks later, Fleming discovers what luck and a little sloppiness can produce." "Newsreel announcer:" "Professor Fleming was examining colonies of bacteria when he came upon one which had gone moldy." "Round the mold, the jelly was clear as if the mold were preventing the bacteria from growing." "Sneader:" "Now, when Fleming picked up this plate and looked at it his first reaction probsay" ""hmm, it's contaminated," and throw it away." "But he thought twice and he realized..." "He had the sagacity to understand what was happening." "Osgood:" "Fleming immediately sets out to confirm his suspicion that a substance in the mold has killed the bacteria." "He calls his new discovery "penicillin"" "after the mold penicillium." "He observes that the mold can destroy the cell walls f the most virulent he observes that the mold canstrains of bacteria.Lls o and when he mixes penicillin with his own blood he's delighted to see that while it's letha bacteria" "it's quite harmless to human blood cells." "But Fleming has difficulty extracting penicillin from the mold." "He manages to recover just enough to test on the kind of surface-wound infections he saw during the war." "In the broth in the laboratory didn't produce enough penicillin to cure infections by applying it topically." "It was fine to kill off bacteria growing on a plate of agar-- you didn't need much penicillin to do that-- but to work in an open wound needed a fairly high concentration of penicillin." "Fleming wasn't ever able to achieve that." "So when he found that his penicillin wasn't working he lost interest in it." "Osgood:" "On may 29, 1929, Fleming publishes the results of his work in thebritish journal of experimental pathology." "He matter-of-factly describes a substance that demonstrates some antibacterial properties." "Perhaps thinking he would return to penicillin one day he carefully preserves the fickle mold and moves on to other research." "In 1929, Alexander Fleming doesn't realize what he's found." "Four years later, German chemist gerhardt domagk discovers a sulfa drug that prevents bacteria from multiplying giving the body's own defenses a chance to destroy them." "(Explosion)" "When world war ii breaks out, soldiers on both sides are given sulfa powder to carry into battle." "If injured, they're told to sprinkle it directly on the wound to thwart the growth of bacteria." "But sulfa proves ineffective against a number of infections and sometimes causes severe reactions." "The man who will take up the challenge is Howard florey chairman of the pathology department at Oxford university." "Florey hires a biochemist, Ernst chain who has recently fled from Nazi Germany." "They begin exploring natural substances that can kill bacteria when they chance upon Fleming's ten-year-old article on penicillin." "Amazingly, a sample of Fleming's mold has been kept alive." "Within months, they extract enough of the crude drug to conduct a few small experiments." "(Air-raid sirens blaring)" "Osgood:" "On may 25, 1940, while britain prepares for another night of air raids the Oxford team attempts the experiment Fleming never tried." "They inject a group of mice with a fatal dose of streptococcus bacteria." "An hour later, flf the group w ith penicillin." "Norman heatley is left to watch over the progress of the mice." "The mice who hadn't had penicillin started looking very sick after about six or seven hours started looking very sick after about six or seven hours 16 and a half hours the control mice were all dead-- the ones that hadn't had it" "but the ones thathadhad penicillin were behaving just normally." "They would run around for a bit, they'd sleep for a bit and if you clicked your fingers, they'd wake up." "The researchers involved certainly had a strong feeling that they were on the brink of something major." "The team actually took some of the spores of the penicillium and rubbed it into their clothing under the lapels of their jacket so that if britain was invaded they could flee perhaps to America or somewhere else where they could begin the research all over again." "Ople working with the penicillin at Oxford certainly had tremendous faith in it." "Osgood:" "But the real test of the drug's effectiveness will have to be made on human subjects..." "And this will require 3,000 times the amount of penicillin given to a mouse." "Desperate for help, florey tries to persuade" "British pharmaceutical firms to take up the challenge..." "But the war has drained them of manpower and resources." "As Germany escalates its bombing raids florey pushes his team to find creative ways to increase production on their own." "Soon penicillin mold is growing in containers scrounged from everywhere." "Finally, they have enough to treat a human patient." "They choose a 43-year-old policeman who scratched his cheek on a rose Thorn." "A staph infection has spread from the tissues of his face to his eyes and lungs." "Heatley:" "None of the sulfa drugs had helped and he was really at death's door and so he was given penicillin and within a couple of days, the effect was noticeable and he made great progress for five days and then the penicillin ran out." "The urine of the policeman had been collected taken back to the laboratory over the proceeding days and they'd recovered penicillin which was unchanged in the urine and purified it as best as they could in those days and re-injected it." "But there wasn't enough, and he relapsed ed for about a month, but there wasn't enough, aand then died." "And Liv osgood:" "Despite the tragedy, a new batch of penicillin completely cures infections in the next five patients..." "But it has taken 19 ress working night and day for months florey knows that if the drug is to save thousands he will have to get help." "He finds it in America where government agencies and pharmaceutical companies figure out how to go from tiny quantities to mass production." "On the Eve of d-day, 1944 millions of units have been produced and stockpiled." "The allies now have enough penicillin to treat all their battle casualties in the invasion of Europe." "They can treat difficult wounds that once would have led to amputation or death." "The mold that flew into Fleming's lab would save thousands in the next few months and millions more in the years to come." "Never before has a single drug done so much." "Man:" "The impact of penicillin is that it has changed who is living in this world and who isn't." "I have often said when I talk to a group of students that you may not feel that any specific vaccine or medicine has allowed you to be here but if you went back only one generation or two generations you might be surprised" "how few of you would be in this audience." "Myself, for instance, in the 1940s" "I was treated with penicillin for septicemia where the physician said" ""two years ago, we could not have done this."" "So I feel like I owe my existence to this one drug." "Now, my children, unless I tell them won't understand they owe their existence to the fact that penicillin was available for me in the 1940s." "It's been a miracle drug." "Osgood:" "Penicillin's wartime success is a triumph for all of science." "Soon, public support for medical research vastly increases as everyone waits for the next medical miracle that will surely come." "Osgood:" "By mid-century, the crippling disease polio is so feared that some parents lock their children away during the summer months when the risk of infection is greatest." "But before long, a new life-saving polio vaccine joins penicillin in what the public assumes will be a long line of medical breakthroughs." "Our confidence seems to be well founded when polio is virtually wiped out in western countries." "So continuous is the string of new vaccines and antibiotics that many observers predict an end to all infectious diseases in the foreseeable future." "At the same time, there is also the belief that surgery is entering its own golden age." "Surgeons are now tackling problems once thought impossible to solve." "Their prime target:" "An organ that for centuries was considered untouchable-- the human heart." "The carnage of world war ii forces surgeons to try risky procedures to save the battlefield wounded." "One of the most dangerous involves soldiers with bullets and shell fragments lodged in the chambers of their hearts." "Few surgeons hto a heart out of fear it might suddenly stop." "Going against conventional wisdom a young army doctor dares to try." "He cuts a small hole in the wall of the heart and secures it with stitches." "Then, blindly by touch, as the heart still beats he locates and removes the metal fragments." "Within days, his first group of soldiers recovers proving that the human heart is not too fragile for surgery." "Buoyed by harken's success postwar doctors hope to save thousands of children born with defective hearts." "Breathless and blue, with swollen fingers and toes their hearts are too damaged to properly circulate their blood." "Few live to adulthood." "Their plight attracts doctors at the university of Minnesota." "Among them is surgeon walton lillehei." "Lillehei:" "These children were dying with simple little holes in the heart that any seamstress could sew up in about 30 seconds." "But these people were dying because these defec center of the heart." "You cannot reach them from the outside and there was no way of sewing in a blood-filled heart that was beating until you empty the heart." "Osgood:" "But an empty heart can no longer pump blood to the body." "Without blood, all the organs deteriorate and the brain suffers irreversible damage in less than four minutes." "It's just not enough time to operate." "The obstacle seems insurmountable." "Then a young Canadian surgeon named bill bigelow begins experimenting with a technique called hypothermia." "He knows that the fierce Canadian winter acts to slow down the hearts of hibernating animals allowing them to survive months without food." "So he tries to get the same effect by chilling dogs and discovers that he can operate on their slowed hearts for more than four minutes." "This convinces lillehei and his colleagues that hypothermia might work on humans as well." "After months of preparation the Minnesota surgeons are ready to try." "A dying girl is wrapped in a special blanket that cools her body temperature 17 degrees below normal." "The doctors have ten minutes to empty her heart of blood locate the hole and make the repair." "They begin at 10:10 in the morning." "Lillehei:" "When we had closed the hole inside the heart and the heart started beating with a normal beat and normal blood pressure, and I looked up at the clock-- it was about 10:15 in the morning" "and I remember saying, "this is it, fellows." "This is the beginning of open-heart surgery."" "Osgood:" "The child's recovery is complete when her body temperature is brought back to normal with warm water." "Lillehei will go on to perform dozens of hypothermia operations." "But these are extremely risky procedures not only for the patient, but for the surgeon who has no margin for error." "Man:" "Many times the diagnosis was incorrect and the surgeon would be standing there looking at a very complex congenital heart anomaly with only ten minutes to carry out some kind of an operative maneuver." "And if you went colder with the body to get more time to protect the brain, you could not restart the heart." "Well, you can imagine the difficulty and of course it was very stressful." "Osgood:" "In an attempt to gain more time to operate lillehei tries an even more audacious procedure called cross-circulation." "He connects the blood vessels of a dying child with those of his parent." "While the father's heart pumps the child's blood lillehei has all the time he needs." "But this is a desperate operation few surgeons dare to try because of the risk it poses to the healthy parent." "For heart surgery to go forward, there had to be a better way." "(Heart beating)" "The human heart sounds like this." "(Heart beating)" "When that sound stops, life stops." "The inexorable rule." "Today, even that rule has an exception." "Medical scientists can, if they must, stop a heart to repair it." "But they must have a substitute heart to do its work and this they now have." "It's a machine." "Osgood:" "This is the breakthrough lillehei has been waiting for-- the heart-lung machine which can circulate and oxygenate a patient's blood while the surgeon operates." "Invented by surgeon John gibbon, it has taken decades to perfect." "By 1956, lillehei is so confident of its effectiveness he dares to repair the heart of a child on." "Surgeon:" "All right, pump on." "Newscaster:" "The mechanical heart-lung takes over." "Debbie's heart is opened." "Osgood:" "The hole in her heart is too large to sew up so lillehei repairs it with a special plastic patch." "This operation, once regarded as unimaginable will soon be routine." "Newscaster:" "Another chapter, another journey." "In human terms it could be measured in the skill of medical scientists who take in their hands the heart and the life of a child." "But the point of our story seems clear." "The age of scientific discovery is just beginning." "A time like ours there has never been." "Osgood:" "Heart-lung machines free the surgeon to try almost anything." "If a valve is damaged beyond repair an artificial one can be put in." "If arteries are blocked, they can be bypassed or replaced thus diminishing the major cause of heart attacks." "Woman:" "There was a whole new feeling that we could really do very effective things about illness and the ability to open up a patient's chest and go in and operate on his or her heart, for example." "That was miraculous to see." "I mean, people who had been profoundly invalided by their cardiac conditions for years-- you can't say they just sort of walked off the operating table, but it was close to that." "Osgood:" "After conquering the heart surgeons tackle another major barrier-- the transplantation of human organs." "In Boston, doctors at the Peter bent brigham hospital take the first tentative steps." "The hospital is already a pioneer in the use of dialysis machines that cleanse the blood of patients with kidney disease." "But for those whose kidneys have permanently failed dialysis is the last stage before death." "In a final attempt to save these patients the brigham doctors try transplanting kidneys taken from cadavers." "Although the new kidneys function perfectly the patients soon die." "Dr. Francis Moore was the brigham's chief of surgery." "Moore:" "Early in this century" "Dr. Alexis carrel did do some kidney transplantations in cats but none of them lived and he didn't really realize why they didn't live but they didn't live because of what we n they were given something new, and they said" ""no, that doesn't belong to us;" "We're going to throw it off."" "Osgood:" "Transplants of skin had been tried during world war ii but only skin from the victim's own body would take." "When foreign skin was transplanted the body's immune system destroyed it as if it were an infectious invader." "The brigham team tries to outwit the immune system with a number of techniques." "They even wrap the transplanted kidney with a plastic bag." "But nothing works." "The body will not accept the one thing that can save it." "Then in 1954, Richard herrick comes to the brigham dying of kidney failure." "He's accompanied by his identical twin, Ronald whose kidneys are a genetic match to his brother's." "The hope is that one of Ronald's kidneys will be accepted by Richard's immune system." "But surgeon Joseph Murray knows that even the idea of removing an organ from a willing donor is highly controversial." "We had to plan a major surgical operation to remove one kidney not for his good but for somebody else's." "Now, the good lord has given us two kidneys and we knew that we could live on one kidney." "But it so basically and profoundly violates what physicians are trained to do-- do no harm." "In this case, you harm a healthy person and turn that person into a patient because you have submitted him or her to a major surgical procedure." "Murray:" "One of my closest senior surgeons said" ""Joe, don't get involved in this-- it'll ruin your career."" "But we had patients who were dying." "They were mostly young and if we didn't do it, who was going to do it?" "And it was the plight of the patients, I think that really kept us going." "Osgood:" "Ber 23, 1954" "Murray gives one of Ronald's healthy kidneys to his brother." "It's the first kidney transplant ever performed using a living donor." "Richard's new kidney works perfectly proving that transplantation is possible for identical twins." "As news of the operation spreads twins in similar circumstances rush to the brigham." "But they represent only a tiny fraction of patients with kidney failure." "For the rest, there is still no hope." "And we entered a very unhappy period that I've called the "black period"" "when patients were sent to us from all over the world who needed a kidney but who'd had no identical twin." "And for a while we mostly sent them back home again." "Others, we tried radiation-- we gave them whole-body irradiation." "Osgood:" "Radiation temporarily destroys a patient's immune cells so they can't attack the transplanted organ." "But almost all the patients die from radiation poisoning or from infections the body is now powerless to stop." "Moore:" "We were on what I called the "knife-edge of survival"-- tip one way, the kidney would reject tip another waradiation." "Was probably going to turn out to be a drug a chemical compound-- it might be a very simple chemical compound-- that would alter the patient's immunology so that the patient would be, you might say fooled into thinking that the kidney belonged there." "Osgood:" "In 1959, a report brings some hope." "It describes a family of anticancer drugs that unexpectedly suppress the immune system." "At the brigham doctors wonder if the drugs will prevent rejection and begin experiments on animals recovering from transplants." "When the dogs remain alive after a year the team feels ready to test the drugs on humans." "When people start surviving as well patients dying of kidney failure besiege the brigham and other hospitals." "With the stampede that started essentially at the end or during the summer of 1963 nobody was prepared for what had transpired." "It was like the Berlin wall going down." "Created a tidal wave of ent" "osgood:" "With the new drugs in hand surgeons begin working with other organs." "Tom starzl transplants the liver." "James Hardy tries a lung." "And the world waits to see" "announcer:" "The world's first heart transplant has been performed." "Medical history was made in South Africa." "Newspapers everywhere carry banner headlines for the dramatic breakthrough." "Osgood:" "On December 3, 1967" "Christian barnard, a south African surgeon removes a heart from an accident victim and places it into the chest of a dying man." "He survives only 18 days..." "His spectacular recovery spurs transplantation to new heights." "By the end of 1971 there have been 170 heart transplants in 17 countries..." "But only 23 patients are still alive." "The average survival rate is just 29 days." "Even barnard's first triumph, Philip blaiberg, is dead." "Rejection still remains the central problem with transplants despite the new drugs." "Starzl:" "Well, in the 1970s" "I think there was a big lying contest that was going on particularly in kidney transplantation where the results with cadaver kidney transplantation were really terrible." "The national average survival of kidneys at one year was 45%." "That means 55 out of every 100 cadaver kidneys that were transplanted were lost within the first year and almost half within the first six months and yet many centers were claiming high rates of success." "Personally, I thought at that time that kidney transplantation was more like a disease than a cure." "Osgood:" "The only transplants that seem successful are those that use kidneys from living relatives who are genetically similar." "But many surviving patients suffer painful side effects and countless infections from taking immunosuppressant drugs." "Starzl:" "Because the margin between effective therapy and fatal complications was so narrow-- right in that zone between the two were found a number of new diseases." "And here you have exotic new infections with new viruses never previously seen in humans." "New blood disorders, new kinds of pneumonias." "It just was a primrose path of sorrow." "Osgood:" "But transplant patients around the world are about to get a second chance at life." "From a few ounces of soil gathered in Norway's remote tundra comes a fungus containing cyclosporin." "The new compound would be vastly more successful at preventing the rejection of transplanted organs." "Shumway:" "Well, this ignited an entire new era." "Programs that had abandoned transplants were springing up again and everybody was getting good results." "And it did something that I had almost begun to despair would never be possible." "And it, of course..." "If it wasn't possible everything that had been invested-- the lives of patients and the lives of health care personnel-- would have been in vain." "Osgood:" "With cyclosporin liver transplants, nearly abandoned, are now routine." "Surgeon Nancy ascher has seen the five-year survival rate climb from 30% to over 75%." "But success has brought new dilemmas." "Ascher:" "From a technical and from a medical standpoint we have reached tremendous pinnacles in the field of solid-organ transplant." "The problems in solid-organ transplant are not the medical and technical ones anymore." "The problems today are that we don't have enough organs for the people who could benefit from transplantation." "Who's going to pay for all these expensive transplants?" "What happens once the patients get their transplants?" "Are they normal?" "Can they get insurance?" "Can they get jobs?" "These are the problems now." "Osgood:" "We once thought if we could beat rejection plantation osgood:" "We once thought if wewould be lifted.Ctionans but there are too few organs to save all the people who need them." "Some patients still suffer severe complications and others just don't make it." "But many people who once faced death are living reasonably full lives now grateful for the gift of transplantation." "As surgeons performed ever more miraculous feats other scientists were asking new questions about the nature of human illness searching for reasons why our bodies fail in the first place." "It's a quest that leads medical science to the very core of our being." "By 1953, James Watson and frcis crick had already unraveled the structure of DNA-- the molecule that makes up our chromosomes and genes." "Many scientists saw genes as a critical piece of the puzzle that explains how our bodies function what we inherit from our parents what makes us individuals and perhaps what makes some of us terribly sick." "When medical researchers turn their attention toward diseases that mysteriously spring up within us, like cancer-- which is ravaging more and more people each year-- some suspect that genes are involved but no one knows how." "What they do know is that the word "cancer"-- not "polio" or "tuberculosis"-- is now striking the greatest fear in our hearts." "Doctor:" "You see that area there?" "That's the tumor there." "Man:" "That red section?" "This vents here..." "Osgood:" "Throughout the 20th century the number of cancer cases has grown steadily and alarmingly." "But one of the most baffling trends is the rise in lung cancer." "Some experts theorize that pollution from industry or automobiles may have something to do with the increase." "But there is no proof for this or any other theory." "In 1948, two British researchers" "Bradford hill and Richard doll-- begin their own search for the causes of lung cancer." "Man:" "I personally thought when we started this study that it was probably something to do with motorcars." "That it was probably something to do with motorcars.Ink th ey were..." "Most obviously had increased enormously." "Roads had been tarred and we knew that fumes from tar could be carcinogenic and if I'd had to bet" "I would have bet it was something to do with the tarring of roads and with motorcars." "Osgood:" "Hill and doll survey hospital patients with and without lung cancer." "They ask where they live and work..." "What kind of job they have..." "The foods they eat and how much they drive..." "And if they've ever smoked cigarettes." "Doll:" "When we started looking at the results it very rapidly became clear that there was a crucial difference between patients with lung cancer and other patients and that was not only did people with the disease smoke cigarettes more often, but they smoked more heavily" "they'd begun smoking earlier in life they had less often given up smoking." "And then when we looked around the world, we found countries where cigarette smoking had been common for some years lung cancer was common." "Announcer:" "To analyze what cigarette smoke contains this cigarette-smoking machine was built by scientists of the Sloan-kettering institute for cancer research." "It mechanically puffs each cigarette in turn..." "And traps the smoke in glass tubes." "The smoke contains a tar." "The tar in the smoke condenses after a time on the bottom of the tubes." "The tar from cigarette smoke was applied repeatedly to the skin of mice." "This shows that it can cause cancer." "Osgood:" "The surgeon general of the United States" "Luther Terry, himself a smoker is finally swayed by the scientific evidence." "In 1964, he issues a public warning against smoking." "There is a definite, significant health hazard associated with cigarette smoking." "Cigarette smoking is the principal cause responsible..." "Foege:" "As he was driving to the state department for the press conference he was going through his notes, smoking a cigarette." "One of his aides said" ""you know, they're going to ask you about that."" "He said, "I know."" "He presented the press conference and then asked for questions." "Someone asked, "Dr. Terry, do you smoke?"" "He said, "no, sir, I don't."" ""Dr. Terry, have you ever smoked?"" ""Yes, I used to."" ""Dr. Terry, when did you quit?"" "He said, "ten minutes ago."" "Osgood:" "Soon there are alarming new findings:" "Exposure to asbestos, certain chemicals even too much sun can cause cancer." "Meanwhile, doctors try radiation in addition to surgery in an effort to cure the disease." "Although patients now survive longer their malignancies sooreturn." "The first cancer to show any promise of yielding to modern medicine is childhood leukemia." "The disease develops when the body's blood-producing center, the bone marrow creates an excessive group of malignant white blood cells-- here, the large purple ones." "They quickly crowd out and destroy other cells in the marrow including platelets, which help the blood to clot and normal white blood cells, which help prevent infection." "Victims suffer anemia, countless infections and bleed profusely." "Once diagnosed these children have only two or three months to live." "In 1949, Dr. Sydney farber of Boston'stal begins to experiment with a radical new approach to fight the disease." "Because leukemia is characterized by the overproduction of white blood cells farber looks for any substance that might impair their growth." "He knows that soldiers exposed to mustard gas suffered such severe damage to their bone marrow that it destroyed their white cells." "Farber experiments with mustard compounds leukemia patientsriments with mustard compounds but the chemicals prove too poisonous to use." "He then tries a less toxic substance, a folic acid blocker that also curtails white cell formation." "Man:" "And lo and behold the leukemia shrunk in a major way in a significant number of the patients." "The normal marrow came back." "That is, their anemia went away their white count came up to normal they could resist infections, they did not have bleeding." "And when the marrow was looked at after three or four weeks very often the marrow was free of leukemia cells and they entered complete remission and that was the good news, that was spectacular that was, in fact, a miracle." "The bad news was that unfortunately all of the patients relapsed." "Because the drug they receive does not destroy all the leukemia cells left in their bodies." "Frei:" "Microscopic disease persisted." "It's like a needle in a haystack." "You couldn't find it by feeling, you couldn't find it by X-ray you couldn't find it by laboratory technique but it was there in enough quantity so that it grew back in a matter of months, maybe sometimes as much as a year." "When it grew back, the cells that grew back were the cells that survived the initial treatment so logically you might expect them to be resistant and they were." "Osgood:" "By the mid-1950s" "Emil frei joins a team of cancer physicians at the national institutes of health." "They want to expand on farber's work by experimenting with additional drugs and they want to lengthen the course of treatment." "But testing becomes impossible because the children die too soon either from infections or excessive bleeding." "Frei:" "Start with the nose the eyes, the throat, the bowel, the lungs and with an inability to control that bleeding." "Uh, if you had five patients like that in a ward of 20 patients it was chaotic, it was enormously difficult." "You could pack the nose in front, pack it in back but that was traumatic and often when the packs were removed the bleeding started again and psychologically the..." "The mothers, the fathers the nurses, everybody knew that once this bleeding started it might be intermittent, but it was probably the end." "Osgood:" "The leukemia team learns how to stop the bleeding by transfusing platelets from family members." "They also administer regular doses of antibiotics which halt the infections." "Now children are living long enough to test the experimental drugs." "Using farber's compound and a new drug simultaneously the team anxiously monitors the effect on their patients." "In 90% of the cases, the disease is halted." "Frei:" "Now, that's an extraordinary achievement if you think of it in terms of the context of the time." "These were kids who came in destined to die of their disease and to have 90% of them turn over and go into complete remission have the disease completely disappear in three to four weeks was the thing that I think persuaded me" "that we were going to get someplace in terms of a cure but it still was true that the vast majority of patients relapsed." "Osgood:" "Despite these setbacks the team has made a critical breakthrough in their understanding." "Using four powerful drugs, they administer all of them simultaneously over several months." "The regiment is difficult to tolerate and patients suffer greatly from so many toxic chemicals in their bodies." "But by the mid-'60s, though no one knows it yet about 40% of these pioneering children will survive long enough to be called cured." "Woman:" "Now we'll tape it down." "Osgood:" "Over the next decade, further refinements bring cure rates for leukemia and several other cancers 0%." "Bring cure rates for leukemia and several other cancersve 7 an optimistic president Nixon declares war on cancer and money flows into cancer research." "But by the mid-1970s frustration with progress sets in." "The main reason is that chemotherapy is not working nearly as well on the deadliest adult cancers like those of the lung and breast." "In truth, the treatment has always been a blunt instrument that happens to kill somecancer cells." "It does not target the still mysterious process that creates the disease in the first place." "Man:" "It became increasingly apparent that if we were to create a new generation of anticancer drugs we'd have to figure out what makes cancer cells grow or rather, what makes them grow abnormally and at that time, virtually nothing was known" "about the origins of human cancer-- the motors that drive the unceasing proliferation of cancer cells." "D discovery the revolution in this field came in 1975, 1976 when Harold varmus and j." "Michael bishop discovered that within normal cells there lay genes which, when they became damaged would now begin to instruct a cell to grow unceasingly;" "that is to say, to become a cancer cell." "Osgood:" "What bishop and varmus discovered is one gene from a special group we are all born with called proto-oncogenes." "Over one's life-span proto-oncogenes help normal cells to reproduce like these in the skin." "But oncogenes are susceptible to damage-- in this case, by too much sun-- and when damaged, they can force cells to multiply when they shouldn't." "We now have one piece of the puzzle." "Then in the mid-1980s" "Robert weinberg and his colleagues find another." "Weinberg:" "By the early '80s we began to realize there was a second class of damaged genes which played an equally weighty role in causing cancer and these came to be called tumor suppressor genes." "E tumor suppressor gen es in their normal incarnation was to suppress the growth of normal cells-- to hold it down, to break their proliferation and when these tumor suppressor genes became damaged as we now realize, they become defective breaks." "They no longer stop the proliferation of cells." "Osgood:" "We now understand that the seeds of cance in the oncogenes that can force unrelenting growth and the tumor suppressor genes that can fail to stop such growth." "And we now know how we get the disease." "We all have at least three general kinds of ways in which our genes may be rendered abnormal." "We may have inherited an abnormal form from our mother or from our father-- that's a hereditary mutation." "We may have a mutation result during our lifetimes because we encounter environmental factors that change the structure of our DNA or we may simply suffer the results of the error-prone process that our cells must undergo to divide." "Every time our cthey copy vast amounts of DNA and there is a certain inborn error rate." "Man:" "Now, you might ask after five billion years of evolution why isn't the copying mechanism perfect?" "Why does it allow this terrible mistake to occur?" "And the reason is kind of interesting." "Cells have to make mistakes when they replicate their DNA." "That's what drives evolution." "If we didn't make mistakes when we copied our DNA we wouldn't be here." "We'd be amoebae or something, however we started because we couldn't have evolved." "So viewed in that context cancer is a side effect of evolution." "It's mistakes that are made during DNA replication that, unfortunately, when they affect the small subset of genes can start a disease." "Osgood:" "Although we now know how cancer begins we have yet to find new cures." "But throughout the century once science has truly understood a disease it has, more often than not, found ways to overcome it." "Weinberg:" "I remind us that the origin of bacterial infections was in the 1880s and the application of this to curing bacterial infections took until the 1930s and the 1940s." "It took two full generations." "Given the dramatic advances in biomedical research it's not going to take two generations before we can convert our insights into the origin of disease into radically new kinds of cures." "They're already slowly coming on-line and in the first decade of the next century we're going to be able to reap some of the fruits of this enormous amount of information we gained the last quarter of this enormous amount ofof the 20th century.Ed in" "although we're still waiting for new cancer remedies modern ms already given us the potential for a life that's longer and healthier than ever before." "At the start of the century, we could cure almost nothing." "Now we expect to be cured of almost everything." "Of course, there are still ailments we're powerless to stop and every so often, a new disease, like aids emerges to confound us and test all our skills." "But medical researchers have learned to fight back." "There are medicines now that seem to be holding at bay the symptoms of some aids patients." "For everyone, the's better diagnostic equipment that can detect disease early enough to cure it." "And we have chemotherapy and surgery and high-tech procedures that save countless lives every day." "What we don't save is money." "Modern medicine can be extremely expensive." "Mes modern medicine can be extremely expensive.W beco how can we distribute medical technology to everyone throughout the world not just those who can afford it?" "In a regional hospital in northern Ghana patients die of liver failure just as they do in the west but no one in this hospital expects a transplant." "Throughout the century scientific medicine rarely reached places like west Africa and life expectancy lagged far behind the developed nations." "But modern medicine is beginning to make an impact here even if its benefits are sometimes hard to see." "Every morning, villagers of savalagu must travel a well-worn path to the local pond." "Throughout this region people are still plagued by infectious microorganisms and dangerous parasites long vanquished in the west." "And water, so precious to life, can harbor germs that disable and even kill with depressing regularity." "This pond is savalagu's only source of drinking water the worms can grow several feet inside a person's body and cause a painful swelling when they are about to emerge." "Victims can suffer for weeks at a time unless they get relief by having the white threadlike worms removed at the local clinic." "Today, northerana is one of the last remaining homes of Guinea worm disease." "But the parasite is on the verge of extinction mainly through the efforts of Donald Hopkins." "Hopkins:" "I mean, here you can see the worm right under the skin." "Osgood:" "Hopkins was instrumental in the campaign that successfully eradicated smallpox in 1978." "He remembers the boost this achievement gave to public health the world over and he's determined to wipe out Guinea worm as well." "Hopkins:" "It's been 20 years since smallpox was eradicated and that was a tremendous accomplishment in itself." "That was a very terrible disease." "It killed millions of people through the centuries." "But in addition to getting rid of smallpox it also changed the way the world thinks about eradication in general because it proved for the first time that, indeed, it is possible to kill one of these diseases altogether" "and remove it from the human experience." "Osgood:" "Diseases like malaria, which are spread by insects may never be eliminated entirely." "But illnesses that rely on people to spread infection are more susceptible to eradication." "(Man instructing villagers in local language)" "Osgood:" "Hopkins has traveled the world over teaching villagers and health workers how to filter Guinea worm parasites from their water." "He also warns people to stay away from ponds when they have emerging worms." "If the worm in someone's body is kept from the water it cannot reproduce and its life cycle is broken." "(Villagers responding to instructor's questions)" "Osgood:" "Hopkins predicts that by the year 2000 there will be no Guinea worm parasites left on earth." "The decline of Guinea worm disease is just one indication of an extraordinary transformation in the health of many developing nations around the world." "Not only is medical aid reaching more people but better nutrition and a declining birth rate are also starting to make a difference." "Hopkins:" "Many other westerners who come here might see the problems that remain and focus only on those." "I'm very much heartened by the progress that we've seen over the last ten years over the last five years and a much longer perspective than that." "I've seen many more children immunized now, for example than were being immunized five years ago." "We're on the verge of eradicating polio within about five years of that, we think." "We have many more communities having access to safe drinking water." "There are many markers of progress." "And certainly the people living in these communities see the progress whether other people from the west can see it or not." "They are well aware of the fact that life, indeed, is getting better." "Osgood:" "It has been the less visible products of medical science-- the vaccines, prenatal care and basic health services-- that have made the biggest impact on the lives of people here just as they did in the west earlier in the century." "Lacking most of medicine's more expensive technologies many people in developing nations are now routinely living to their 70s-- quite a change from just a few decades ago." "As people everywhere grow older societies will be challenged to care for an aging population." "But at the start of the century, many of us died in infancy and few of us ever reached our 70s." "Foege:" "My grandmother had ten children." "Only five of them foege:" "My gransurvived infancy.Hildren." "Five went on to become adults, one being my father." "Five went on to become adults, he was destined to die in 1953 given life expectancy at that time." "But he saw all of the 1950s and then he saw all of the 1960s and incredibly he saw all of the 1970s and then he saw all of the 1980s and the amazing thing is he's now seen the majority of the 1990s." "I think one of the most remarkable things of this century of science has not been what happens in an emergency room or in an intensive care unit or in the laboratory." "It's the information now available to the average person." "The average person actually knows about tobacco and knows about cholesterol and knows about the risks of the sun knows about using seat belts." "So the information given to the average person to run their average day can actually affect what happens to them in the future." "And at the beginning of the century we were struggling just to get scientific knowledge." "At the end of the century we're struggling to actually respond to that knowledge."