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• W2940791118 abstract "Waiting to board a flight recently, I glanced at my pass and saw that I was in zone 5. I am always in the higher (usually last to board) zone numbers, and I playfully said to the person next to me, “If they had a zone called infinity, my boarding pass would say infinity +1.” He didn't respond. Maybe he was math challenged or more likely, just duly wary of conversations initiated by strangers. Then I heard the agent ask someone to come to the “podium, ” and as in every case when I hear this, I resisted making the correction. (The gate agents, of either gender, are almost always at least 5′ 4″, and even if shorter, no podium is on the scene.) And then I listened to the early-boarding siren to a veritable periodic table of esteemed passengers’ clubs: gold, silver, and platinum; actually, I mean, Gold, Silver and Platinum, to use the appropriate corporate uppercases. I pondered other advance-boarding categories that creative airlines might invent, particularly for customers with element-based disorders, such as a Calcium Club or Iodine Club, for people with hypoparathyroidism or hypothy-roidism, respectively. Untreated, such people are quite ill and might well deserve early-boarding status (although thankfully, good treatment modalities for both conditions have been around for some time). And beyond clinical conditions, might there be a Selenium Club for passengers who always travel when there is a full moon or a Mercury Club for members who hope the flight will land early? After the higher-zone passengers and then I boarded, and the plane started to taxi out, I mused on all of the other chemical elements that could be the basis of special patient boarding zones. Soon, my mind (a hopelessly vagabond thing) drifted to cobalt. It was soon time to be doing my July Editorial, so I decided to look into the 1934 Nobel Prize in Physiology or Medicine given to George Whipple (Fig. 1), George Minot (Fig. 2), and William Murphy (Fig. 3). This thought came to me because Alfred Nobel and the prizes he launched are amateur avocational interests of mine (1). Whipple had found that anemic dogs fed liver preparations recovered (2). That a simple dietary intervention might address the human condition (initially termed “macrocytic anemia” and later, “pernicious anemia”) was a very exciting notion. Subsequent work by Minot and Murphy, the latter a student at the time, bore this out for the human situation. All of this had the ring of a Rudyard Kipling just-so story. But, as the plane lifted to 30, 000 feet, I recalled that a hematology acquaintance had expressed his opinion to me some years before that there was one member of this Nobel triad who may have been very lucky. What follows is a synopsis, with every effort to be fair to the dramatis personae. Whipple had indeed seen remarkable improvement when his dogs were fed liver, but years later, several experts offered the revisionist idea that their anemia was not a result of a nutritional deficiency at all, but rather to a chronic hemorrhagic condition. I looked at Whipple's paper (2), and the description of the animals certainly conveys that their reported anemia was diet induced and was rigorously confirmed by hematologic criteria. But then, there is the question of whether the liver modality (raw or cooked, parenteral, or even injected) met the standard of a definitive treatment. In 1934, and even into the 1940s and 1950s, the Nobel Prizes in the Physiology or Medicine category were sometimes less pristine than those in Physics or Chemistry, in that in the former category, findings that had great clinical merit or had a strong foundation for optimism, sometimes were recognized, even though it was manifestly clear that the underlying basis for the patient findings was not known. Sixteen years later, Edward Kendall and Philip Hench shared the Nobel Prize in Physiology or Medicine for their discovery of the therapeutic effect of cortisone for rheumatoid arthritis. The underlying mechanism was not discovered for many years, but I doubt there is anyone who would today contest their Stockholm recognition. For pernicious anemia, the mechanistic breakthrough was the discovery of the so-called intrinsic factor, by William Castle. He showed that these patients were B12 malabsorptive, as a result of a deficient presence or operation of a gastrointestinal factor. The curious name, intrinsic factor, now arcane in hindsight, was supposed to complement the action of the active liver principle seen in the clinical studies, which had been, by then, tagged with the name “extrinsic factor.” Medical nomenclature, indeed most scientific nomenclature, is often more chaos than elegance. George Hoyt Whipple (1878–1976). Photo credit: Science History Images / Alamy Stock Photo. George Richards Minot (1885–1950). Photo credit: Science History Images / Alamy Stock Photo. The definition and isolation of vitamin B12 (Fig. 4) by two pharmaceutical firms (Merck in the United States, and Glaxo in the United Kingdom) were triumphant capstones. William P. Murphy (1892–1987). Photo credit: Science History Images / Alamy Stock Photo. Chemical structure of vitamin B12 and derivatives. The 1934 Physiology or Medicine Nobel Prize committee cannot be faulted on its 1934 decision. Whenever we oxymoronic “amateur experts” think such an honor was bestowed before the full picture is known, we must envision what was on the jury's table and in the dossiers at the time of their deliberations. To be sure, the two cases of obvious error in the Physiology or Medicine Nobel Prize [Johannes Fibiger and Antonio Caetano de Abreu Freire Egas Moniz (yes, Moniz had that many given names)] can be held up as cases where not even a semblance of mechanism was known (and could not possibly have been known, given the available methods at the time), but these were errors based on hope. That such has not been repeated in all of these years says a great deal. The mind is a curious thing. Boredom can be an un-pleasant state when waiting to board a plane or at other times. I am not a smartphone addict, so there are times when I am indeed bored. (Maybe I would be too if online.) In this case, that boarding area got me thinking and made me aware that the periodic table and medicine are old friends and allies, with cobalt and B12 just coming to my forebrain as one vivid case." @default.
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• W2940791118 date "2018-07-01" @default.
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• W2940791118 title "The Frequent Flyer Periodic Table and an “Element” of Hematology" @default.
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