The article Patrick sent out — brain-eating amoeba in Seattle’s tap water. We also talked about GP IIb/IIIa receptor antagonists (like abciximab and tirofiban) that have been derived from or inspired by molecules found in viper venom. Here’s a paper that briefly talks about how several of these drugs came from a “systematic search of snake venoms with the potential to specifically inhibit the GP IIb/IIIa receptor.”
Talking about protamine sulfate being derived from salmon sperm, Kim reads a short portion of this 1926 article.
Protamines were discovered in 1874 by Miescher in the spermatazoa of the salmon. Subsequently it has been shown that protamines are present in the spermatazoa of the carp, the common herring, two species of mackerel, three of sturgeon, four of salmon, and in eight less common species of fishes. Protamines have not been found in plants nor in animals other than in the spermatazoa of fishes.
This paper briefly details the discovery of heparin in 1916 by Jay McLean, then a second-year medical student at Johns Hopkins. As with many important discoveries, heparin wasn’t an overnight success; it would take decades before it was pure enough to be used in trials and its utility could be fully realized. Here is a more detailed accounting from Dr McLean himself, the most interesting aspect of which is the stark disparity between medical (and premedical) education of today and that of 100 years ago — one could enter medical school with just two years of undergraduate education, and having three years, Dr McLean was allowed to enter Johns Hopkins as a second year medical student.
Human sperm contains nucleoprotamines and historically it has been speculated at times that protamine sulfate may cause anaphylaxis at much higher rates in persons who have had vasectomies. The evidence for this is limited to case reports, however, and the truth of the situation is probably messier, since heparin appears to sensitize certain positively charged proteins, and NPH insulin is also made from protamine. Most important for those doing some holiday shopping, you can purchase salmon-sperm-derived protamine on Amazon Prime.
Our word-of-the-week was iatrogenesis, which was coined by Ivan Illich and is most commonly used to refer to medical harm. Here’s a brief quote from Illich, published in the Lancet in 1974:
Rising irreparable damage accompanies industrial expansion in all sectors. In medicine these damages appear as iatrogenesis. Iatrogenesis can be direct, when pain, sickness, and death result from medical care; or it can be indirect, when health policies reinforce an industrial Organisation which generates ill-health: it can be structural when medically sponsored behaviour and delusion restrict the vital autonomy of people by undermining their competence in growing up, caring, ageing; or when it nullifies the personal challenge arising from their pain, disability, and anguish.
Another important ahead-of-its-time work from Illich is his brief speech, To Hell With Good Intentions.
In our EBM moment, we touched on surrogate markers and the importance of considering patient-oriented outcomes rather than just disease-oriented outcomes.