Today, I am thankful for those who are unafraid to dig into the dirt to find a treasure.
As the son of a dry cleaner, I’ve learned an important lesson early in life. People do not like dirt – the unclear mixture of dust, grime, and soil that accumulates on our skin, possessions, and (God forbid!) our clothes. Entire industries are founded on the premise that humans abhor anything ‘dirty’. So, we have invented household cleaners, sanitizers, disinfectants, and detergents with the sole purpose to protect us from whatever horrific microscopic entity might reside on our counters, tables, desks, and other surfaces. We spend millions each year investing in stain removers and other cleansers that might remove any visible evidence of stains, splatters, or blemishes that have accumulated on our clothes, carpets, or cars.
But, what is I told you that dirt actually has its place in a healthy world?
A study published in 2014 by scientists from Johns Hopkins University demonstrated that newborns exposed early in life to dirt, dander, and household germs actually have a lower risk of developing allergies and asthma later in life. Ironically, our bodies need exposure to these foreign entities as a means to prime our immune system to get busy doing its thing. In fact, a well known scientific principle, known as the ‘hygiene hypothesis,’ postulates that children who are ‘saran wrapped’ in an ultra-clean environment are at risk of developing hypersensitive immune systems that predispose them to allergies. With all this in mind, I’m left pondering an ever-perplexing question: Should I really be pressing my 18-year old middle son to cease his life of slobbery and clean up his sty of a bedroom?
Let me tell you the story of two men who are verifiable proof that, irrespective of what parents once warned, playful waddling in the mud can reap massive rewards. In the late 1930s, an aspiring Ukrainian-born chemist and microbiologist at Rutgers University, named Selman Waksman, was interested in the decomposition of microorganisms that live in the soil. Together with his counterpart Albert Schatz, Waksman believed that our surrounding environment contained priceless compounds that could alleviate human suffering. In other words, the duo devised and designed a methodology of ‘digging in the dirt’ to discover drugs. In 1939, they signed an agreement with Merck, which would provide their Rutgers laboratory with research funding to discover novel antibiotics in exchange for any patents/processes he might invent. Five years later, on this exact day (Oct 19) in 1943, the duo would discover a compound, which they called streptomycin, in a soil-based fungus. After some testing, they unearthed that streptomycin effectively curtailed the growth of Mycobacterium tuberculosis, the bacteria responsible for tuberculosis.
A few preliminary, anecdotal reports in infected patients suggested that streptomycin was a promising candidate against tuberculosis. So, in 1945, the FDA approved streptomycin without any clinical trials (a requirement that would not come into being until the enactment of Kefauver-Harris Amendment to the Federal Food, Drug, and Cosmetic Act in 1962). The next year, Merck started to mass-produce streptomycin from a manufacturing plant in Elkton, Virginia.
In the financially constrained, post-war era, the United Kingdom purchased about 50 kg of streptomycin for testing in patients with tuberculosis to see if novel drug this was worthy of further investment. The decision as to how to best use the streptomycin was left to the Medical Research Council (MRC), which was a UK advisory council responsible for medical fund distribution. The MRC was a well-respected entity that had transformed medicine in the early Twentieth Century. The MRC established a committee to design a trial to evaluate streptomycin. After much deliberation, the committee opted to perform a trial using a 1:1 randomization scheme. About 100 young adults 30 to 50 years of age with acute progressive bilateral pulmonary tuberculosis were enrolled. At the time, the standard of care for tuberculosis was bed rest, often in sanitariums with other infected patients. Several clinical researchers, including Drs. Marc Daniels, D’Arcy Hart, and Bradford Hill, designed a trial to compare streptomycin and best rest vs. bed rest alone.
The results of this study were instrumental in confirming the efficacy of streptomycin. After 6 months, the overall mortality was 7 percent (4/55) in the streptomycin group vs. 29 percent (15/52) in the control group. After 12 months, the mortality was 22 percent in the streptomycin group vs. 46 percent in the control group. The higher mortality in months 7 to 12 as compared to months 1 to 6 in the active treatment group was the direct result of streptomycin resistance, a new phenomenon not fully understood at that time. Hence, this small trial of about 100 subjects not only confirmed the value of streptomycin, but also confirmed the benefit would likely be short-lived, unless streptomycin resistance could be curtailed. Fortunately, two other, novel agents, para-aminosalicylic acid (PAS) and isoniazid (INH), would soon be discovered and used in combination with streptomycin to effectively treat tuberculosis.
Dr. Selman Waksman would go on to develop other important agents, including novobiocin and actinomycin D. However, his discovery of streptomycin would not only garner him a Nobel Prize in Physiology or Medicine but would revolutionize the care of millions around the world infected with tuberculosis. In essence, TB-infected patients were no longer subject to a ‘life of consumption’ in a sanitarium.
Sometimes, ‘digging in the dirt’ is not such a bad idea. So, the next time your child refuses to clean his room, you might find some solace in knowing they might be on the cusp of discovering the next great wave of novel antibiotics.
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