Sic Transit Gloria

SIC TRANSIT GLORIA JULIUS POMERANZE, M.D.* The medical profession is often unaware (and probably does not care) to whom priority in medical research belongs. It may be of historical significance to know that so-and-so was the first to accomplish and/or describe the procedure, therapy, or disease. This is oflittle importance to the practicing physician. It concerns him as little as it should because there is in such knowledge no true relationship to utility. He can learn little that is not already available in product brochures and subsequent investigative studies which have reached scientific print. Historical precedence does have great importance to the individual investigator of a new therapeutic modality. There is great meaning in a reference to one's initial labor. It certainly is a strong bolster to the ego to be mentioned in association with an important event or method oftreatment . It is especially gratifying to be recognized as the first investigator. It certifies that one is professionally respected and "loved." To behistorically discounted and forgotten as an important individual in intimate association with a weighty discovery can only mean rejection. This is a very heavy cross to bear in a world weighted with most disturbing events. How lightening recognition can be to a poor mortal! How distressing its lack! These Freudian effects are only softened with time and, in a practicing physician's case, an accumulating and gratifying medical practice. Fortunately for me, time has passed, and I am very busy professionally. This problem is now open to discussion. I can discuss it without bitterness, although there is still some regret. It would be nice to be remembered by those who gathered some courage because ofmy initial efforts and drew information from my original publications and discussions. It is sad to think that all of those nice people with whom I so pleasantly discussed * Present address: 54 Old Country Road, New Rochelle, New York. 457 these and other problems have passed beyond my purview. Those were the "good old days." During May, 1957, I published in the Proceedings ofthe Societyfor Experimental Biology and Medicine the first clinical publication in world literature related to an important new drug [1]. The article was titled "Clinical Report ofa New Hypoglycemic Agent" and was the result of morethanayear ofclinical andpharmacologic experimentationwith a new and now extremely useful oral hypoglycemic agent, since better known by its generic name, phenformin, and its trade name, DBI. This publication was the result ofmore than one year ofpainful, painstaking, difficult, and stressful evaluation of a new and challenging drug. I knew that it was chemically related to synthalin, which had proved itselftoxic thirty years before. The clinical evaluation of a drug chemically close to synthalin would require the most intimate and careful introduction, and for approximately six months no other investigator was permitted to evaluate phenformin! The first problem was to translate the dosage from that effective and non-toxic to animals to one suitable for human use. A dose without toxicity needed to be established, since it had not previously been given to humans. Carefully and cautiously I began the long investigation, always searching for the proper effective dose without side effects or toxicity. Fortunately, toxicity never appeared, but I did find many side effects and made their recognition and method ofprevention matters ofrecord. These studies indicated that phenformin effectively lowered blood sugar levels within three hours oforal administration to patients with severe as well as mild diabetes mellitus. I also offered information concerning a metabolic effect of phenformin in non-diabetic subjects. I pointed out (as is well known today) that insulin requirements ofpatients with severe diabetes were significantly reduced when phenformin was added to the regimen. The warnings, anticipating severe side effects—that is, metallic taste, nausea, loss of appetite, and change of bowel habits—were carefully delineated. The maximum daily dose was established. I pointed out that the side effects were inherent in the drug and served as a useful dose regulator and safety device The problem ofketonuria and ketonemia caused by overzealous treatment and accidents ofthe gastrointestinal tract was carefully outlined. Its 458 Julius Pomeranze · Sic Transit Gloria Perspectives in Biology and Medicine · Spring 1969 designation as a...