- The Quest for Cortisone by Thom Rooke
This book is about one of the most famous drugs of the so-called pharmaceutical revolution of the twentieth century. Cortisone, a hormone of the adrenal cortex, became a panacea for several chronic diseases in the early 1950s. Whereas the chemical research into the steroid structure of the adrenal cortex hormones of the 1930s was motivated by the determination of their life-maintaining principle, the evolving concept of stress-related diseases during and after WWII led to completely different clinical uses of the drug as a major antiphlogistic, anti-allergic, and anti-inflammatory agent. Cortisone did not heal any disease, but, when administered continuously, successfully suppressed the symptoms of widespread and costly chronic illnesses, such as rheumatoid arthritis, allergic reactions, and autoimmune diseases. Despite the huge impact cortisone had on clinical practice and the long-lasting debates about its benefits and harms, literature on its history is scarce. Thom Rooke is one of the few people to deal with the topic since Norbert Klinkenberg's 1987 history of cortisone and studies from Vivane Quirke, David Cantor, Harry Marks, and Nicholas Rasmussen.1
As a professor of vascular medicine at the Mayo Clinic, Rooke is well aware of the imponderabilities of chemical research and medical practice and is an admirer of great scientists—"nice guys, saints, eccentrics, and geniuses" (p. 43) pursuing their objectives against all odds. The book begins with the introduction of these main actors and their achievements and then focuses on the "hunt" for the active principle of the adrenal cortex, through military steroid research during World War II and the decisive clinical test in 1948. It reaches a climax when the chemist Edward C. Kendall and rheumatologist Philip S. Hench were awarded the Nobel Prize in 1950 and concludes with the deaths of Ernest Hemingway, John F. Kennedy, Edward Kendall, Walter Alvarez, and Russell Marker— all of them involved in the story of cortizone. [End Page 131]
The study presents a lot of archival material, mostly based on online material published by the University of Virginia (especially the Philip S. Hench Walter Reed Yellow Fever Collection); on sources from the Mayo Clinic archives; and on autobiographical work, Nobel lectures, obituaries, and scientific publications by the contemporary witnesses. There are no references to current research into the history of medicine and pharmaceuticals. Accordingly, this monograph is rather not intended for historians, but for laypeople interested in a heroic epic of scientific endeavor and progress. Rooke generously overlooks the fact that nobody planned or even desired cortisone and that this drug was an unforeseeable product of changing experimental cultures, knowledge contexts, and research policies.
In this respect, the title of the book is misleading from a historical perspective (there was no "quest" for cortisone), but it serves the purpose of capturing the reader's attention. This holds true also for the narrow focus on a couple of American scientists and their discoveries, ignoring the impact of new laboratory techniques (like chromatography) or new physiological theories (like the stress concept that evolved during World War II). It is not an issue that the Swiss chemist Tadeus Reichstein, who shared the Nobel Prize with Kendall and Hench in 1950, is not part of the story; you may always choose a case study and prefer a certain focus to another one. But that he is labeled a "supporting actor" (p. 43) demonstrates the teleological concept of scientific progress pursued in this book: the idea that through passion, mistakes, setbacks, intuition, breakthroughs, and a little luck truth is finally found. Yet cortisone was no truth, but a powerful drug the effect of which was clearly evident in clinical practice but not understood by anyone, the first clinical test being based on a false assumption. The early enthusiasm about its incredible power was soon replaced by a critical discussion of its side effects and potential misuse, a discussion that anticipated evidence-based medicine. Cortisone solved an epidemiologic and economic issue, but it also entailed unprecedented therapeutic problems and a significant shift...