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.