Blumberg, vice president for population oncology and senior member of the Institute for Cancer Research at Fox Chase Cancer Center in Philadelphia, is also professor of medicine and anthropology at the University of Pennsylvania. He received his M.D. from Columbia University College of Physicians and Surgeons in 1951 and his Ph.D. in biochemistry from Oxford University in 1957. He shared the 1976 Nobel prize in medicine and physiologyfor his role in identifying the Australian antigen in human blood and discovering its association with serum hepatitis—a development that led to a dramatic reduction in the transmission of hepatitis B through bload transfusions.
Blumberg was intervicwed March 24 by Peter Gwynne, director of editorial operations of THE SCIENTIST. This is an edited version of their talk.
In "Plague you talk about the Daedalus Effect, that a solution to a problem often creates new problems by is very existence, and the new problem then creates need for new solutions. Does the scientific community recognize that effect sufficiently
BLUMBERG: I would say yes, because very often a person will end a scientific talk by saying, “Now we know how much we don’t know,” or, “We’ve done this, but obviously there’s a good deal more to be done.” Like everyone, I recognize that the more you know the more you know you don’t know. In effect, I tried to put it in an article that Renée Fox and I wrote, which was the source of the piece in the television program. We tried to formalize that in a sense. Q: In that March 1985 Annals of Internal Medicine article you wrote with Fox, you apply it to social issues that stem from scientific advances.
BLUMBERG: That was the particular example we used, but there are plenty of examples in science where problems are really social issues arising from biological problems. The other aspect of it is that you never have perfect knowledge. Realizing that is extraordinarily important, because that means you don’t sacrifice the good for the perfect. Quite often people say, "I can’t feel that the problem is totally solved because I don’t know every possible thing there is to know." Obviously, you want to be cautious; this can’t be used as an excuse for sloppy work, for saying."What the hell, I know a couple of things, and that’s it." The more you know, the better off you are. But it’s amazing—particularly in medicine and a lot of applied sciences— how little you have to know in order to be effective.
Q: Can you give an example? BLUMBERG: Vitamins. In 1905 or there-about a very large percentage of the personnel in the Japanese navy was suffering from beriberi. Many people in the navy hospitals were dying from it. A Japanese naval surgeon made a hypothesis: He had noticed on shipboard that Europeans didn’t get beriberi very often while the Japanese did. He decided it was because of the European diet. He tested that hypothesis in an interventional way by feeding these Japanese people a European diet, and they got better.
Actually, his hypothesis was wrong. He thought it was the protein. It’s not the protein, it has to do with vitamins, which were also part of the diet. He didn’t know that. He had imperfect knowledge—but he knew that the diet had to be changed in the direction of the European one. So, despite having very little information, be was able to control the beriberi.
This was before the First World War. It wasn’t until the 1920s and ‘30s that vitamins were even named. It wasn’t until much later that they were chemically characterized, and we still don’t fully understand how they work. But the point was that even without total knowledge they were able to change the situation.
Another interesting aspect is that even though you know empirically what to do, unless you have a good scientific model, it's not adopted widely. Even though you can show empirically that something is better, people won’t accept it fully until there’s a good explanation.
BULMBERG: The basic reason probably is that I’ve always been a movie buff. Every Saturday when I was growing up we’d go to the movies. My interest also derives from my experience teaching a course in medical anthropology at the University of Pennsylvania for many years, which evolved into a case study type of presentation— We would look at the social and psychological aspects of a disease as well as its biological and medical aspects. Over the years, I built up some knowledge about particular diseases from that perspective.
Q: How much of your time did it take making "Plagues"?
BLUMBERG: The percentage of time was small: 4 or 5 percent. But it was rather intense at times. The directors were very considerate, so the work fit into my own research activities. The time I spent exclusively on TV production was when we were on location. We traveled quite a lot and we did perhaps half of the film in a relatively small number of days. The rest of the film was done in Philadelphia. That would take a morning, or in some cases a whole day; traveling time was insignificant and when you actually shoot it’s not a lot of time.
What did take a lot of time was the research. I had a general familiarity with many of the subjects we wrote about, but they often required a great deal of additional reading of a historical nature. For example, the work on influenza—I read a great deal more about that.
Q: You did this research yourself?
BLUMBERG: I did a large part of the research. We also employed several very competent researchers who came up with information, references and so forth, that I wasn’t aware of. I would usually read what they had done and write an essay on each of the topics. Then I tried to pick topics in which I was very interested in any case.
Q: Do you see the show as a vehicle to entertain or to educate your audience, or both? SLUMBERS: Compared to the general things people see on television, it’s hard to see a story on death, destruction, plagues and enormous epidemics as fitting into the usual concept of entertainment. On that basis I would say it’s primarily educational. On the other hand, people find educational things entertaining if they’re appropriately presented in an acceptable way.
Q: How did you get involved in "Plagues"?
BLUMBERG: A Philadelphia woman decided that the city ought to have a television program on medical history, and the Public Broadcasting System station here became involved. I was asked to organize the program, decide its intellectual content and also be the narrator. The PBS station, WHYY was very encouraging and helpful.
Q: Did they have any audition tapes of you or did they just pluck you from behind a drugstore counter like Lana Turner?
BLUMBERG: I often kid producer Alan Goldberg and say he discovered me in a drugstore.
No, I’ve never done a television program. But after they decided to go ahead, we formed what I thought was an outstanding scientific advisory committee, with community people, mostly academics but also from industry—who are involved in medical research or history. We had a rather strange meeting in which there appeared to be some controversy about what we would do. But I took careful notes and afterwards, when I reviewed them, there was a fair amount of agreement. Based on that, we submitted a list of possible topics for a 10-or-12-program series—and we short-listed them. The program we did, "Plagues",was Number One on the short list, though the intention from the beginning was to do a series.
Q: There’s often a divide between scientists and people who write about science. How easy or difficult did you find it to cooperate with the TV professionals?
BLUMBERG: I can’t say anything about the problem in general, but in my specific case the relations were just wonderful. They were very considerate of the fact that I don’t know anything about television. I’m not an actor, and I didn’t know how to read lines— or say lines, because I didn’t actually read them—and in a way they trained me.
It’s very tiring; to film all day long. It is a strain because it’s often against time constraints, the sun’s going down or an airplane is coming over or you have to finish by a certain hour—so there was a good deal of trying to rush to meet one of multiple deadlines. But it seemed to work out very well.
People got along fine, I enjoyed them and I think of them as friends.
Q: On a more conceptual level, how difficult was it to hit the right technical note for your intended audience?
BLUMBERG: That was a constant dynamic between primarily myself and the producers, Alan Goldberg and Marilyn Nissenson in particular. The way we went about it was somewhat unusual. Usually when you do something like this you end up with a script weeks or months before you start shooting. But in our case, I would write an essay and give it to Alan and Marilyn and they would write a script. They also determined when we would show film clips and when we’d have interviews. They would then show me the script and I’d read through it.
I think it’s fair to say I didn’t accept any five continuous words during the entire process. Part of that resulted from the scientist’s desire to give detail. You have to give exceptions: You can’t say...This always happens,...but rather...This always happens, except there was a study in such-and-such a time when this didn’t happen.” I decided that, to the extent I could, I’d never say anything I didn’t know actually to be so.
On the other hand, you had to express things in a few words. It was a terrific experience for me to learn how to say things precisely, because what the television cats know is how to use the image to convey a lot of the meaning. It finally began to dawn on me that you could do that. I realized it after seeing the film.
I’d often be shown the script within minutes of the time we were supposed to start filming. Quite often, when I’d read this script, my idea of what should be said changed. So Alan and Marilyn and I would be debating about the script literally up until the minute we filmed.
Someplace along the line, Alan told me that "Casablanca" had been filmed that way; they never had a real script, they made it up as they went along. Some inconsistencies in the plot reflect this. I liked that idea, and Alan said it gave it a dynamic. It’s also nerve-wracking, and I think the film suffered from that—it’s a bit jerkier than it otherwise might be. But in a funny way I enjoyed that, because there was a constant excitement about it.
Q: Should scientists in general learn these skills, how to speak glibly and to convey fairly complex concepts to a lay audience— as they to try to Popularize their work?
BLUMBERG: There’s a big difference in the way scientists talk with their colleagues and with a more general audience. The American Cancer Society for years has held press conferences where scientists speak. You can understand what people say there, because the scientists want the media people to comprehend it. The information they convey is detailed and technical, but you can understand it, because they’ve eschewed the abbreviations that we always use in science. That’s a mantle you put on to make your fellow scientists recognize that you’re sophisticated. You resort to this "priestly" language that excludes others. I don’t think scientists, in general, should communicate that way with each other, because it’s a kind of one-upmanship.
Q: Traditionally the scientific community has been suspicious of scientists who seem too eager to appear on TV and in other media as popularizers of science. Is that attitude changing?
BLUMBERG:I think this concern is less now than in the past, mainly because some of them continue in very active scientific work. Incidentally, I don’t think I fit into that category. I’ve done this one program; I don’t see myself as a media figure.
Q: But do your colleagues?
BLUMBERG: Not as far as I can tell. Ninety-eight percent of the people whom I know haven’t seen the program; my guess is that it’ll never be more than 10 or 20 percent who do. I don’t get stopped in the street; one program, one hour, doesn’t make you a media personality
Q: Did you have to be a bit of a performer in front of the camera?
BLUMBERG: My instructions from Alan and Marilyn were not to perform, and I think I would have found it difficult to do so. I’d also have had to join another union. When you’re a narrator, as long as you’re telling what’s happening, you’re not an actor.
Certain things happened that got me a little upset. One of them was when we were doing a scene in Australia and I was standing on the stairs of the house built by a man who imported rabbits and other things from Somerset. The text was that he’d brought the stained glass for the windows, and I’d point at the window; he’d brought the wood for the staircase, and I’d point at the staircase; and he’d brought the china for the dining room, and I’d point to the dining room, off to the right. So the cameraman said, "Barry, don’t point off to the right that way, because it throws off your focus. Point to your left or ahead of you." I said, "Wait a minute, Francis, I can’t point over there if the dining room is off to the right." So he said, "Who the hell is going to know?" "Francis, I know," I said. "If I point off to the left instead of the right, I’m acting. If I point to the dining room, I’m narrating."
The other thing that bothered me was that we were planning to do the background scenes on malaria in Fiji. A day or two before we were to fly there, there was a military takeover, so we decided not to go there. Instead, we did some of the malaria scenes in Hawaii. Well, there’s never been malaria in Hawaii. Of course, we didn’t say we were in a malarial area, we didn’t specifically identify Hawaii. But that bothered me.
That brings up this interesting border between fantasy and reality. In science we deal with that all the time, because a hypothesis is something you conjure up out of your head. You see something going on in the world and you mike up an explanation. Then, unlike with a novel or folk tales or myth, what you try to do is reject the explanation. But for a while you’re dealing with that fantasy. It’s a fantasy in the sense that it comes from your imagination, or should. Then you keep testing it, and some place along the line that fantasy turns into reality, because you can do something about it—like make a vaccine or a medicine or some treatment So there’s this transition from a made-up fantasy to a reality, which is validated in medicine by application.
Movies are like that. In some respects, movies are the most real medium we know of, because people are moving, they look three-dimensional, the color’s fantastic. But it’s light on a screen. Some of the most interesting movies deal with this question of reality and fantasy.
What I’m saying is that in science we deal with this train of vision when we make up an idea and bring it into reality. This business with Hawaii bothered me, because one of the important things in science is to know where you are, how far along in the conver- sion from fantasy to reality.
Q: You mentioned in "Plagues" that Max von Pettenkofer drank the cholera preparation. There’s been some controversy recently over Daniel Zagury, who’s injected himself with what he regards as an AIDS vaccine. What are your thoughts about self-experimentation?
BLUMBERG: There are a variety of reasons why this isn’t a good practice, but one of them is that it’s very hard to be objective when you do that. Sometimes the argument is made if you’re using a new medication or vaccine that somebody has got to use it first, and the inventors should be the people who do so. That has a dramatic quality to it, and it can have some merit. But in an experimental situation, if you hold to a position as strongly as Pettenkofer did, who believed that taking cholera bacillus by itself wouldn’t cause cholera, there’s no way you could see any other result.
Now the fact is, Pettenkofer got sick, and a couple of other people got very sick. He equated cholera with death, whereas we know that many people have milder types and recover. There’s no way he could see that this result disproved his hypothesis, because he was too wrapped up in it. So one of the major problems in science is designing a study in such a way that you’re equally prepared to support it or reject it. If you do an experiment on yourself, the reason you’re doing it is that you want to prove a particular point. You’re making it very difficult to get an objective evaluation.
HISTORY’S LESSONS FOR TODAY
Q: Can we draw lessons from the history of dealing with infectious diseases that indicate what our social policy should be in dealing with AIDS?
BLUMBERG: Science is eminently a historical activity; we always build on the past, on prior experience. A lot of scientists feel that the only thing that counts is the last experiment. I can’t believe that’s the case, because what happened before has a bearing on how you interpret what happened today. AIDS is different from other epidemics, yet there are some similarities.
I’ve always felt that understanding history allows us to understand the present problem. For example, there’s the question of quarantine. Well, quarantine sometimes works and sometimes doesn’t. It’s highly unlikely that quarantining people with AIDS in the United States is going to have any impact on this epidemic. There’s simply no evidence that that’s going to do anything of value. We look to the past and see that people attempted quarantine and it was of no value. There are times when it is valuable, but this isn’t apparently one of them.
There’s the question of the development of vaccine. We didn’t go into that in great detail in the film, but one of the disturbing things about this virus is the difficulty, conceivably the impossibility, of making a vaccine. I don’t think it’s impossible; I think people are awfully clever at figuring out ways of doing things.
Generally speaking, I think the management of the AIDS program has been reasonably good. The official responses have always been considered and tempered and humane. As for the public response, in general, this society is concerned about it and wants to act in an intelligent way.