Who Goes First?: The Story of Self-Experimentation in Medicine By Lawrence K. Altman (review)

Who Goes First?: The Story of Self-Experimentation in Medicine. By Lawrence K. Altman. With a New Preface. Berkeley: U of California P, 1986, 1999. Pp. 454. $18.00. If the homework you must do for a book review is any indication of its final assessment , then the paperback edition of Who Goes First? by Lawrence K. Altman, the New York Times medical correspondent for the past years, would get an unqualified A. Re-reading it 13 years after its original publication has prompted me to check my memory on Galen; finally read William Ian Miller's Anatomy ofDisgust (its book reviews had tempted for too long anyway) and Shadows in the Sun by Wade Davis [1, 2]; go on one of those hunts only library geeks can enjoy (I stopped telling my friends years ago about how much I enjoyed my occasional library research marathons since their blank faces were too painful) while researching guillotines and Lavoisier's death; and delve into recent self-experimentation, ranging from poisonous toad-licking to applying lacquer to one's skin to the effect of exercise on one's memory. Anyone who re-reviews a book for publication must feel he has something new to say, or the author has added something new to review—or both—or, as in my case, must truly have forgotten he ever reviewed it in the first place. Not an admission I make eagerly but it is the truth. I do remember reading Who Goes First? and I do remember teaching it in a college course on Exploration of the Self (along with another slightly more controversial account of self-experimentation, Carlos Castaneda's The Teaching ofDonJuan: A Yaqui Way ofKnowledge) , but I had forgotten I reviewed it when initially asked. As a combination ofwriterly honesty and a miniself -experiment of my own, I am reviewing Who Goes First? without the benefit or distraction of having read my first review prior to writing the second. At the risk of repeating myself, here goes. Originally published in 1 986, Who Goes First? grew out of a long-standing interest the author developed in medical school. As he explains in the original prologue, fetal tissue he and his classmates at Tufts used in an embryology class in 1958 came from planned hysterectomies. Between the time of the scheduling and the hysterectomies , the women had agreed to voluntary abstinence from birth conUol. Technically , as Altman points out, the researchers had performed abortions, not hysterectomies , on some of the women. Beginning with a New EnglandJournal of Medicine article in 1972, Altman began a more systematic study of what he quickly perceived to be an scandalously understudied phenomenon, as unresearched as it was pervasive : self-experimentation in medicine. Along the way, he conducted very important interviews—surprisingly (as he notes) the first time anyone had done so in a methodical or extensive way. These interviews included such important self-experimenters as Werner Forssmann, the pioneer of cardiac catheterization; William Harrington and the idiopathic thrombocytopenic purpura self-transfusion story (for this author, who trained at Washington University while Bill Harrington was still there, reading that Dotsy, the wife of Thomas E. Brittingham III, M.D., another ITP self-experimenter, tore into C. V. Moore for allowing Brittingham's near anaphylactic brush with death was worth the price of the book alone); Victor D. Herbert, a self-deprived folate-deficiency researcher; and Robert A. McCance and Elsie M. Widdowson, both British researchers in nutrition during the 1930s and '40s who made important contributions to the WWII Allied diet. Like Dr. Altman's New York 154 Book Reviews Times medical columns of the past 20-plus years, these interviews with groundbreaking scientists—from unknowns to Nobel laureates—and their spouses reflect a meticulous, searching yet respectful medical intellect enriched by hisjournalistic experience. They are priceless windows into the practical, everyday aspects of a type of experimentation that can be described, at times, as scientific solipsism turned creative. Self-experimentation in medicine, as Dr. Altman informs us, goes back at least to Santorio Santorio (1561-1638), who studied bodily changes, especially weight, as a result of eating and waste production. Although Dr. Altman includes Santorio in...