'Microbe Hunters' with a modern sensibility: 'The Remedy' examines germ theory's scientific origin and social diffusion

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I can trace my early career interests along a vector of science literature that began in elementary school, with Paul de Kruif’s 1926 classic, Microbe Hunters, continued with Berton Roueche’s wonderful New Yorker “Medical Detective” stories in junior high, and was followed by Horace Freeland Judson’s Eighth Day of Creation, an inspirational history of molecular biology’s formative years,  in high school.  When I was touring colleges and came across the centrifuge used in the famous Meselson-Stahl experiment performed to demonstrate the semiconservative replication of DNA, I was sold.

In many ways, the de Kruif stories, written as profiles in heroic science, have aged the least well; the hagiography retains a certain charm, to be sure, but loses its immediacy and sense of resonance.  I’ve long wished Microbe Hunters could be updated in a way that more fully contextualizes the researchers’ work and achievements – not to tear down these heroes, but to humanize them, representing their accomplishments – and their failures – with greater nuance, but similar empathy, while placing the science in a broader and more complete social context.

In reading Thomas Goetz’s The Remedy this weekend, I felt that my wish was finally granted.

Goetz may be best known for a previous role, Executive Editor of Wired.  Today, he’s co-founder (with Matt Mohebbi, of Google Flu Trends fame) of the health analytics startup Iodine, and Entrepreneur-in-Residence at the Robert Wood Johnson Foundation, and has an abiding, perhaps unavoidable interest in health and medicine.  His late father was a prominent academic diabetologist, his mother worked as nurse for decades, a sister is a practicing surgeon, and another sister was tragically killed in Uganda in 1998 while working to advance public health with the Minnesota International Health Volunteers.  He has done them all proud with this effort.

Goetz’s easy familiarity with medicine suffuses the pages of The Remedy, a thoughtful, patient, ultimately fascinating account of the struggle of 19thcentury science, and society, to come to grips with the germ theory of illness, and develop new technologies to take on one of humanity’s oldest scourges, tuberculosis.

Goetz focuses on two protagonists in particular, beginning with the German Robert Koch, whose ambition and careful methodology propelled him from obscurity to fame, culminating in the identification of the causative agent of tuberculosis, the elusive Mycobacterium tuberculosis.  We are introduced to Koch’s struggles: the righteous,  including his disputes with distinguished skeptic Rudolf Virchow, who believed germs were at best the consequence, not cause of disease; the petty — most notably his bitter, ongoing battle with Louis Pasteur for recognition and acclaim; and the misguided – such as his mistaken belief that he had identified a cure for tuberculosis.  Had he only applied the rigorous precepts for proof that he meticulously developed, and that had guided his work for years, the tragic error, and ensuing fall from grace, it seems, could easily have been avoided.

Who was arguably the first person to suggest the great Robert Koch might have been mistaken?  An ambitious British physician trying to gain traction as a writer, and who had traveled to a scientific demonstration in Berlin expecting to be dazzled by Koch, yet returned disappointed though with a fascinating story to share.

Yet it wasn’t his critique of Koch that catapulted this writer to fame; rather, it was the scientific methodology of his character Sherlock Holmes that eventually introduced the world to Arthur Conan Doyle.

Though Conan Doyle eventually quite medicine to focus on writing, “Conan Doyle had gotten a great deal out of medicine,” Goetz writes:

“An education, a sense of stature and accomplishment, and most of all, a world view.  His was by now a thoroughly scientific mind, whether or not he still chose to participate in that science.  Medical science informed how he thought; it influenced how he wrote; and quite clearly, it was inseparable from what he wrote.”

Conan Doyle’s Holmes – much like Koch at his best– was, Goetz observes, “precise, methodical, and keenly perceptive.  He ably appropriates the techniques of the bacteriologist to discern what seems otherwise invisible.”

This approach appealed to Conan Doyle’s audience because, as Goetz writes,

“science was longer seen as some radical challenge to European culture; instead, it seemed in many ways to define the culture.  This was true in Germany and France and especially in Britain, where science seemed to touch something in the Victorian spirit.”

Understanding how germ theory made this leap, and evolved from revolutionary science to cultural expectation is Goetz’s preoccupying question – or as he frames it more generally, “how does a scientific revolution build towards social change?”  He continues,

“This is perhaps the central question of the past 150 years, a period when science has, time and again, transcended a eureka moment in the laboratory to compel a broader cultural shift.  This trajectory lies behind everything from nuclear energy to plastics to the Internet.  But as essential as this trajectory is for the fabric of our daily lives, the process too often slips by without our noting it, or even our know how, precisely, the progress actually happens.”

Moving from science to culture, Goetz writes, requires two related but distinct activities, characterized by different processes and associated with different burdens of proof.  The first step is scientific – achieving the sort of paradigm shift Kuhn describes (and that Jim Manzi nicely reviews in Uncontrolled) by providing compelling data that meet established standards of proof – and waiting for holdouts to die off.

The second step – originally conceptualized, Goetz says, by Freeman Dyson – is the “skills and inventions” (to use Dyson’s terms) that come from new scientific ideas.  In this view, as Goetz puts it, “the revolution lives in the industry, not the idea.”  It’s the technology, the industry, the practical outcomes of science that we see around us that ultimately permits the revolution to move from science to culture.

Thus, while Koch may have developed the key principles for defining a causative agents – Koch’s postulates continue to be taught in medical school today – the cultural adoption of this mindset required not just concrete examples of success (such as Pasteur’s famous demonstration of an anthrax vaccine at Pouilly-le-Fort, which culminated, according to Goetz, with Pasteur raising his arms in triumph and crying “Here is it! Oh ye of little faith!”), but also characters such as Conan Doyle’s Sherlock Holmes, an engaging representation of the scientific process Pasteur and Koch refined, preached, and quite often, practiced.

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