1990 BOOK PRIZE WINNER: SCIENCE : On Jane S. Smith’s “Patenting the Sun’

He was a Boston Irish lawyer who made it big on Wall Street, enjoyed tailored suits and private railway cars, and was pals with Franklin D. Roosevelt, his law partner. His name was Basil O’Connor and he headed the National Foundation for Infantile Paralysis during its heyday in the 1950s.

O’Connor knew little of the science behind the polio vaccine his foundation’s money went to develop. At meetings of its scientific advisory committee, he’d sit at the table with the experts as they rattled on about adjuvants and viruses, saying little. But sometimes, as the discussion wound down, he would raise some pointed question that forced the scientists back on track.

The scientists, Jane S. Smith recounts in her fresh, sharp-eyed account of the discovery of the Salk vaccine, were interested in polio, in the principles of immunology, in the puzzle of viruses. But the foundation’s job, as Smith represents it, “was not simply to advance the sum total of human knowledge” about polio but rather to prevent, or cure, or otherwise do something about it.

Even by O’Connor’s time, such a targeted, clinically driven research strategy was out of fashion among many scientists. For example, John Enders, who later shared a Nobel Prize for his work on polio, dismissed the suggestion that his lab work on a vaccine because, as Smith represents his position, “his lab was not set up for polio vaccine production.” Adds Smith: “Since no lab was, this can only be taken to mean that vaccine production was not something Enders wanted to do.” Neither did David Bodian, a Johns Hopkins researcher who contributed much to understanding polio. “He was a pure scientist,” the author writes, “and his colleagues in the Johns Hopkins group were all pure scientists, and they were not in the business of making vaccines.”

“Conquer” disease without single-mindedly attacking it? The notion seems paradoxical to some, troubling. But, say many researchers today, it is fruitless to build would-be treatments of cures upon an edifice of basic science whose underpinnings are shaky; a foundation must first be erected, the structure set firmly in place. Best to let talented researchers follow their scientific noses, freeing them to study basic life processes unfettered by the need to Find a Cure; the clinical advances will follow.

Indeed, one study of breakthroughs in heart and lung medicine some years ago found that of the discoveries that led to them, four in ten did so only in retrospect; no one could have guessed . . . Then, too, many today note that rapid progress in understanding the AIDS virus was made possible only by a store of knowledge built up in genetics and virology long before the disease itself had surfaced.

It is this ancient tension in medical science, between the pursuit of health and that of knowledge, that runs all through Smith’s story. In the years leading to the introduction of the Salk vaccine, these differing values, she writes, sometimes “clashed like angry snakes climbing a single pole, hissing and biting as they struggled for dominance.” Basil O’Connor wanted to defeat polio, and saw knowledge gleaned from basic research as a means to do so; whereas, to the researchers he funded, like Salk, “understanding the deepest mysteries of life was the end, and money raised for polio research” was one way to reach it.

As for Salk himself, Smith pictures him as motivated primarily to prove the worth of a “killed-virus” vaccine--one based on priming the body’s immune system to recognize and destroy a live polio virus by first exposing it to a killed one. Salk was intelligent, hard-working and ambitious. And by any standard but the very highest, he displayed impressive abilities and achieved much. Still, he comes across here as a scientific middleweight, forever fussing over details, his vaccine breaking no new ground scientifically. Salk never won the Nobel Prize for his achievement, nor was he elected to the National Academy of Sciences. And Smith uncovers no new groundswell for his inclusion in either. That he first got the vaccine to work, and did so before most deemed it possible, apparently counts for little.

All this, of course, is in marked contrast to Salk’s reception outside science, where he was lionized. Ten days after the vaccine was pronounced safe and effective at a huge press conference at the University of Michigan in Ann Arbor, Salk was at the White House receiving a special citation from President Eisenhower. Thousands of letters poured in. The nation was grateful. Salk was a national hero, a symbol of achievement in the service of humanity.

Still, in Smith’s telling, it is sometimes O’Connor, as much as Salk, who is the hero; O’Connor who, however tyrannical, however much his methods offended more refined sensibilities, stood for the human side of the biomedical research enterprises--the ordinary people, the victims of disease, the children who were most vulnerable to polio and the parents who feared for them.

Terror gripped parents each polio season. And Smith, who as a child participated in the vaccine’s first field trial, conveys it well. Indeed, parents of the ‘50s generation serve almost as a Greek chorus in her drama, crying for the deliverance of their children.

Salk had earlier vaccinated only a handful of children at the Watson Home for Crippled Children and at the Polk State School, both outside Pittsburgh. A massive field trial of the vaccine, the largest ever conducted, involving almost 2 million children, would be needed before it could be given to everyone.

The parents signed on eagerly. They protested when a health district was excluded (after a Walter Winchell column questioned the vaccine’s safety). They contrived to get their kids doses of gamma globulin on top of the vaccine, threatening to distort the trial’s results. “Few of these parents,” writes Smith, “determined to use every chance to protect their children, gave a hoot about statistical validity.”

(“One of the simplest and most inspired touches in the campaign to recruit participants was the decision to have ‘request’ forms rather than ‘consent’ forms,” Smith writes. “Parents could either request to participate or refuse; the altered language changed their agreement from a risk to an honor.”)

While the early chapters, about the polio foundation, polio victim F.D.R., Basil O’Connor, and the laboratory science that led to the vaccine, are compelling enough, the book fairly tingles with excitement as the field trial, the great scaling-up, nears. Because now, abruptly, the stakes were raised. No longer was it just a young researcher’s personal struggle, squabbles among scientists, bureaucracy and politics. Now 2 million children were being deliberately injected with a virus that, presumably killed, was supposed to protect them from a dread disease.

It was time for Medicine to slide over the line into Public Health.

Roughly, the medical perspective is that of diagnosis, treatment and cure, public health’s that of prevention; medicine studies disease in the individual, public health in populations as a whole. Traditionally, in the United States, public health has lived in the shadow of the physician’s miracle cures and the surgeon’s heroic operations.

But the polio field trial conducted across the United States in 1954 was, for sheer daring, every bit their equal. “No one had ever reported any ill effects during any of the trials in the Pittsburgh area,” writes Smith, “but the fact remained that so far Salk had made most of the vaccine he tested, done all the vaccinations, kept all the records, and interpreted all the results.” But now, if something went wrong, tens of thousands of children might contract polio, be left paralyzed, etc.

The vaccine did work and, once introduced on a national scale, cut polio from 135 cases per million to 26 over the next decade. But first came an awful fright. The successful field trial led to vaccine production by six different drug companies. And one of them, in 1955, made a mistake.

The first reports came in from California: Vaccinated children were coming down sick. Before the National Institute of Health could shut down the offending lab, 204 children and adults got polio. Three quarters of them were paralyzed. Eleven died.

Here, knowledge did not precisely correspond with health; scientifically, polio was a solved problem, yet children were getting it. just as they had two years before, while Salk and his colleagues in Pittsburgh still toiled to perfect their vaccine. “If they needed any prodding to hurry in their work,” writes Smith, “they had only to pass the four hundred new polio patients admitted to Municipal Hospital that summer.”

They did hurry. Thousands who can never know who they are, and who have lived normal lives in the years since, owe their health to the vaccine. Millions of parents owe to it their piece of mind. Smith’s account is a fit expression of our collective gratitude.

Nominees In Science and Technology

PATENTING THE SUN; Polio and the Salk Vaccine by Jane S. Smith (William Morrow)

SONORAN DESERT SUMMER by John Alcock (The University of Arizona Press)

GREEN RAGE Radical Environmentalism and the Unmaking of Civilization by Christopher Manes (Little, Brown)

THE CONTROL OF NATURE by John McPhee (Farrar, Straus & Giroux)

DISCOVERING by Robert Scott Root-Bernstein (Harvard University Press)