Now that the hullaboo and the ballyhoo associated with the Nobel awards is over, perhaps it is time to reflect on why these awards have acquired the prestige they have with particular reference to the awards for Medicine and Physiology and how India has fared in its 114-year history.
It is true that the Nobel awards have carried an aura around them ever since they were initiated in accordance with Alfred Nobel’s will way back in 1901. Nobel himself was an inventor who is credited with the invention of dynamite and gutta-percha among other things. He remained a confirmed bachelor all his life and was known to have developed strong aesthetic sensibilities. While his own professional interests were confined to physics and at the most chemistry, he made provisions for inclusion of medicine and physiology in his will where he conceptualized these awards.
On the humanities angle, he believed that awards were also called for excellence in literature and promotion of peace and amity. Ironically it is these awards, which have generated the maximum controversy. Looking at the list of the literature laureates, the exclusions appear more notable than the actual winners — Leo Tolstoy, Thomas Hardy, Joseph Conrad, Henry James, Andre Malraux, Hermann Broch, Robert Musil, D H Lawrence, James Joyce, W H Auden, Marcel Proust, Franz Kafka, Virginia Woolf, Graham Greene, Mark Twain, Ezra Pound and the more familiar names in India like Prem Chand, Sarat Chandra Chattopadhyay and Tarashankar Bandyopadhyay. Only four people from Africa have made it thus far — Nadine Gordimer, J M Coetzee, Naguib Mahfouz and Wole Soyinka. Mathematician Bertrand Russell was awarded in literature, as was Winston Churchill — for his speeches during the last War.
The Peace category has acquired maximum prestige despite the numerous controversies over some inexplicable decisions. Gandhi never made it despite numerous nominations. In an unprecedented gesture, the Nobel Foundation apologized for this lapse, which was clearly politically motivated. Nevertheless when I interviewed Linus Pauling, the only winner of peace as well as a science category (chemistry), he candidly admitted that the peace award carried far more meaning for him than the chemistry one. Which was hardly surprising when we as physicians recall that the most illustrious and worthy medic of the last century who serves as a role model for all of us — and shall continue to do so — was made a laureate not in medicine/physiology but in peace and deservedly so. His name was Albert Schweitzer.
The pertinent question is whether the Nobel awards can be taken as the ultimate parameter of overall human excellence. My answer would have to be in the negative. The awards were created in a world that had not witnessed radioactivity, cinema and the genome.
One only has to peruse through the volume TOP 1000 SCIENTISTS FROM THE BEGINNING OF TIME TO 2000 AD by Philip Barker available in the reference section of the Nobel Library in Stockholm and regarded as the most authentic list of the greatest scientists of all time. Sifting though those who lived through the 20th century and hence would theoretically would have been eligible for the awards, one finds numerous names, the most notable being Ernst Mayr who was never even nominated — primarily as his work could not be justifiably included in the five categories specified.
The logical inference therefore is that the Nobels, despite being the numero uno among the awards available, do not encompass the entire range of human activity which needs to be taken into account while evaluating excellence.
Nowhere is it more blatant than in the category of medicine and physiology. As medical students, we were all treated to a galaxy of all time greats who have made landmark contributions towards the development of our profession. The first name that comes to my mind is William Osler. A legend in his lifetime, he through his astute observations was able to enunciate outstanding principles which continue to be sacrosanct in modern medicine nearly a century after his passing away. The veneration that he automatically commands is ubiquitous. Not many would quibble when I describe him as the greatest clinical physician of the modern era.
Osler was never nominated for the award. Nether were Hamilton Bailey or Robert Hutchison. The reason for this omission is obvious; the awards are heavily geared to gauge basic research rather than clinical excellence. One look at the list of the laureates and this becomes crystal clear. Barry Marshall and Robyn White were the last full time clinicians to be bestowed this honour for their work on helicobacter.
When I peruse through the list of psychiatrists who won the Nobel, I find three names. The first is Julius von Wagner Jauregg who suggested injection of malarial parasite into the human blood stream for treatment of general paresis of insane. The second was Egas Moniz who suggested frontal lobotomy for the treatment of schizophrenia. Before we gasp in horror, we have to take into account that there was no antibiotic available to treat neurosyphilis in Jauregg’s time and antipsychotic medications were unknown in Moniz’s time. The third psychiatrist to win the Nobel was my fellow professor when I taught at Columbia University, Eric Kandel (who won it with Arvid Carlsson, a pharmacologist and my fellow editorial board member with the Journal of Psychiatric Research). Eric’s magnificent work focussed on determining neurotransmitters for memory — again basic research although having strong clinical relevance.
It is nobody’s case that the people who have been awarded are undeserving in any way — just that contributions that have a greater clinical relevance do not find favour.
Lasker Awards attempted to fill in that gap but being limited to medicine were unable to acquire the aura of the Nobels. It is worth mentioning that one outstanding Indian clinician did win the Lasker. His name was Rustom Jal Vakil and his work focussed on the role of reserpine in clinical practice.
We all know that the only Indian to win the Medicine and Physiology Nobel was Har Gobind Khorana — and he had become a US citizen long before he was made a Laureate. His work again had no direct and immediate clinical relevance being entirely basic in nature.
I made an attempt to determine how many people from India had been nominated for the Medicine/Physiology Nobels. The Nobel Foundation has a stipulation that bars them from disclosing nominations for 50 years. When I wrote to the Nobel Foundation, I expected to be provided a list until 1964. Unfortunately, I was provided a list only until 1953.
Sir Leonard Rogers was nominated for his path breaking work on Kala-azar in 1907, 1917, 1929, 1930, 1931, 1934, 1935 and 1940. Robert McCarrison was nominated in 1920 and 1937 for his brilliant work on avitaminosis. Upendranath Brahmachari was nominated for his work again on Kala-azar in 1929 and 1942. William Burridge was nominated in 1937 for his work on natural stimulation.
I must confess I do not understand what natural stimulation means hence cannot comment on it. But all the others were nominated for their clinical excellence.
The obvious name missing here is Yellapragada Subbarao whose brilliant work on tetracycline fetched the Nobel for Benjamin Duggar but left him unsung.
Let us take this opportunity to salute these nominees, all of whom have made stellar contributions.
My sincere hope now is that the medical profession getting together and initiating an award for clinical contribution, which revolutionises practice of clinical medicine, awarded annually to be decided by an international jury. If administered judiciously, I am confident it would acquire comparable prestige to the Nobels.
I do not believe a true stalwart hankers after an award. Such recognitions are primarily for lesser mortals like us, as they would serve to remind us of the indefatigable lugubriation that goes into any clinical innovation.
by Dr Ashok Jahnavi Prasad