America has won more Nobel Prizes in medicine than any other nation: it’s easy when you have the money, the technology, and people from every other nation
In 1977 the sociologist Harriet Zuckerman published a comprehensive study of the American Nobel laureates in science called Scientific Elite . She used these words of Simone Weil for an epigraph: “Science today must search for a source of inspiration above itself or it will perish. There are just three reasons for doing science: (1) technical applications; (2) chess game; (3) the way toward God. (The chess game is embellished with competitions, prizes and medals.)”
Of all the prizes awarded to the players of the game of science, the Nobel is the most prestigious. Since the Second World War, Americans have won more of them than any other country—we have fifty-four laureates in the category of physiology or medicine. The Germans won most before the war, and their decline may be attributed to Adolf Hitler himself.
In 1936 the Nobel Peace Prize was given to Carl von Ossietzky, whom the Nazis had thrown into prison three years before. Hitler’s petulant response was to declare that henceforth no German would be permitted to accept a Nobel. The scientific community took the hint, and the first wave of émigrés to America included eight men who had already won the prize, Einstein, Fermi, and Bohr among them. They were followed by three who would win it soon: the physicists Pauli and Stern and the biochemist Henrik Dam. Bohr, Pauli, and Dam returned to Europe after the war, the others remained here. There were two “waves,” as a scientist at Rockefeller University put it: “First they came fleeing from the Nazis, and then, about twenty years later, they were fleeing from the Russians.” Most of those who came were mathematicians and physicists, but their contributions to the accelerated physics of the space program necessarily spilled over into biology and medicine.
When scientists are confronted with the question “Why have the Americans so dominated the awards?” their first response is usually a qualifying smile. They speak of the immigration already mentioned, of the number of laureates who were born somewhere else. Then the obvious truth is brought forward: “We have more money and more people doing science.” There is a degree of sophisticated reservation about what real bearing the glamorous prize can have on intellectual work of the highest order. The justice of the awards is rarely questioned, but examples are given of people who should have won and did not. Oswald T. Avery is a classic case: Avery did his work on DNA—the genetic code—when he was quite old, and he died before Stockholm got around to him. Timing is everything. (According to Nobel’s will, “The prizes for physics and chemistry shall be awarded by the Swedish Academy of Sciences; that for physiological or medical works by the Caroline Institute in Stockholm …”) The institute’s explanation is instructive: “Avery’s discovery in 1944 of DNA as carrier of heredity represents one of the most important achievements in genetics and it is to be regretted that he did not receive the Nobel Prize. By the time the dissident voices were silenced, he had passed away.”
The rare and more dramatic instance of a discovery that directly defied the accepted opinion is exemplified by Gerald M. Edelman, who won the prize in 1972 for his discovery of the molecular structure of antibodies, which rationalized the study of immunology. His ideas were, at first, simply not believed, a not altogether unfortunate circumstance. If they had been, he has stated, “they could have been snapped up by laboratories with much more expert people than myself, and I think it [the structure] would have become clearer much earlier, had they paid attention. But they didn’t, and so I had a chance in a leisurely way to explore this whole business.”
Unable to publish his early findings in the appropriate journals, Edelman sent a one-page letter to the Journal of the American Chemical Society :
Sir: Reaction of gamma-globulin with sulfhydryl compounds, sulfite, or performic acid resulted in a marked diminution in the sedimentation coefficient and molecular weight.… These findings suggest that human gamma-globulin contains subunits linked at least in part by disulfide bonds. The possibility that linkages other than disulfide bonds are involved has not been excluded.
Thirteen years later, after he and his group had determined the complex structure of the largest molecule analyzed to that date, he was astonished to find that his citation for the Nobel Prize referred precisely to the original single page: there was now a “firm foundation for truly rational research, something that was previously largely lacking in immunology.”
It is generally held that the institute has been rather conservative in its selections. One historian complained that an examination of the prizewinning discoveries would yield only “hard little pellets of empirical knowledge … shaken free of any conceptual matrix in which they are unaccountably embedded.” Had the prize existed in his day, Darwin would not have won it: the theory of evolution did not directly produce any facts. Einstein won “for his services of Theoritical Physics,” and specifically “for his discovery of the law of photoelectric effect.” Nobel’s will stipulates that the prizes should go to “those who, during the preceding year, shall have conferred a great benefit on mankind,” a phrase that looks toward a visible therapeutic result. In 1927, for instance, the Austrian Julius Wagner-Jauregg won the prize for producing a temporary abatement of the symptoms of advanced neurosyphilis by inoculating patients with malaria.
Although the conservative bent of the prize committee has been loosening up, the problem is still inherent in the nature of things. A greatly simplified scenario would run like this: X publishes a radical notion; ten years later A, B, C through Z, stimulated in large part by X’s idea, discover the facts that prove X was right. Who gets the prize? The bestowal of joint awards is a partial solution, but the institute has set a limit of three members from any one scientific group.
In her study Zuckerman discovered one experience common to most laureates: the prize had a disruptive effect on their lives and work. “The year I won the prize was horrible. Well, it was wonderful, but I didn’t do any work whatsoever,” said one winner. We are all accustomed now to the bombardment of the media, but it was eighty-one years ago that Marie Curie, after her first Nobel, wrote to her brother: “We are inundated with letters and with visits from photographers and journalists. One would like to dig into the ground somewhere and find a little peace. …”
Most of the money for research in America comes through the National Institutes of Health and the National Science Foundation. The NIH has both an internal and an external body; it carries on its own work and funds research across the country. A peer-review system determines which projects deserve support; qualified scientists are invited to come to the NIH and review the proposals for which funding is asked. The system has worked well but is steadily subject to the intensely competitive nature of all this as well as special pleading, logrolling, and ordinary human frailty.
There is a great deal of research done in the private sector—the drug companies are an example—but this has been goal-oriented and less likely to produce discoveries of Nobel proportions. Private companies, moreover, are careful to restrict publication, for obvious competitive reasons.
America is, for the moment, in the lead in science if the Nobel Prize is allowed to be a measure. In an age obsessed with technology, the bigger and richer a country is, the more people will be doing research. The Russians are a little paranoid about their science; they are wary about publication, and the free flow of information, which is essential to the cumulative effort science has now become, is stunted. America is eclectic in style; we have a great variety of people doing a great variety of things on their own initiative, not at the direction of the state. It is in the American tradition to be hospitable to the eccentric loner working for the love of knowledge only, not worried about specific commercial application.
“The desire for money is leading a lot of the brightest kids into medicine,” one chemist told me. “But not to worry—quite a few of them will get bored and go back into research.”