Thursday, March 12, 2015

Dr. Max Gottlieb

Sometime during high school I got on a Sinclair Lewis jag.  I read Babbitt, Main Street, Arrowsmith, It Can't Happen Here, and Elmer Gantry.  (For some reason I didn't read Dodsworth.)  I no longer can recall what it was about the writing that drew me in.  Evidently I enjoyed the first one, which was either Babbitt or Main Street, though now I'm not sure which.  I suppose the rest were read in search of a similar reader reaction.

Several in my high school cohort went on to become medical doctors and a few went into doing medical research, my brother included.  I wonder if they read Arrowsmith and, if so, whether it served as inspiration for them.  I did not follow that trajectory for career path.  Yet some of that book stayed with me all these years later, while the storylines of the others I mentioned are long forgotten.

Last week I saw that the film version was on TCM and that piqued my interest, so I recorded it with the DVR for later viewing.  This showing was part of a retrospective on Helen Hays, who plays Leora Arrowsmith, the wife of the title character. The movie itself was released in 1931, only a few years later than The Jazz Singer, the first talkie.  It was directed by John Ford and featured Ronald Coleman in the title role.

It is quite viewable, even now, though there are a few observations that might help a current viewer get through the film.  First, each scene is very short and unlike films today in that respect.  Ben Mankiewicz, who introduced the film and gave a little anecdote at the conclusion, said the Ford was  a heavy drinker but swore off alcohol during the shooting of the film.  Then at night, after the shooting during the day, he destroyed a lot of the footage, so his work editing the film would be much easier and the film would get done faster, this so he could return to his drinking sooner.  Hays discovered this, protested what Ford was doing, and the two had a tête–à–tête that was quite unpleasant for Hays, but did lead to a cessation of the practice.  In any event, it is notable how brief the scenes are.

The second observation is how pure, perhaps stereotypical, the characters are.  There are the good guys and the bad, the knowledgeable scientists and the hacks, the noble pursuit of truth and the crass chasing of money coupled with unabashed promotion in the newspapers to further that end.  I don't know if this purity of types is as strong in Sinclair Lewis' book.  But it does contribute to the irony in the story.

The last observation is how science is cast.  The pursuit of knowledge is the highest possible calling, higher even than concern for the welfare of fellow human beings.  Science is also viewed as a solitary enterprise, the intrepid researcher alone in his lab with his experiments.  It is the product of a disciplined mind that is patient enough to see the truth through careful observation of the results from controlled experiments.

The embodiment of science in the story is Dr. Max Gottlieb, who is the role model for the story's hero, Dr. Martin Arrowsmith.  Gottlieb is wise in the ways of science and the ways of human nature.  He values research and views medical practice itself as mainly hand holding with the patient (in other words, not science).  He values the friendship of other scientists and prefers their company to being with others.  He can be honest and open with them.  He also fits the stereotype about scientists at the time (and perhaps still).  He is a German Jew who speaks with a notable accent.  He is slender and wears glasses.  (I'm not sure whether they were pince-nez or had ear pieces.)  He has especially long and thin fingers.  He looks old and near the end of the film he is seen doddering before he passes away from a stroke. I'm not sure how old the character is meant to be, but the actor who played him, A.E. Anson, died several years later at age 56.  (I am now 60, which is part of the reason that the Dr. Gottlieb character is more interesting to me than the protagoist.)

All these virtues notwithstanding, Gottlieb does something quite terrible to Arrowsmith.  Bubonic plague has broken out in the West Indies.  Arrowsmith may have found a cure in his lab and he heads down to the West Indies to see if his serum can rescue the population.  Gottlieb asks that Arrowsmith divide the population into halves and administer the serum only to one half.  The other half would receive a placebo.  By observing the outcomes for people in both groups, one could determine whether the serum was effective and rule out the possibility of a cure based on a "placebo effect."

Let me leave aside the science itself, where there is nothing said about sample size for such hypothesis testing, what was already known about plague at the time, and other variables such as dosage of the serum or how far along the patients were at the time they received the vaccine. This sort of hypothesis testing is anathema to experimenting with human subjects.

Soon after I took over the SCALE project on campus in the late 1990s, I was informed by Larry Faulkner, then Provost, and himself a chemist, that we couldn't randomly assign students to different sections of the same course, some of which had ALN (online learning) and others of which did not.  Think of how comparatively benign this sort of random assignment would be.  ALN was in its infancy then so whether it improved, harmed, or didn't matter for learning in a course was an issue of interest.  Yet Faulkner made it clear that students had to express their preference in instructional mode.  We could not make the choice for them.

Now think of how much more dire the consequences were for those exposed to plague in the West Indies.  Everybody in that circumstance wanted the injection.  Who could deny their wishes?  Only Max Gottlieb can articulate this thought.

Initially Arrowsmith goes along with Gottlieb's request.  But when Leora dies from plague Arrowsmith has a temporary breakdown and then, in the wake of his hysteria, allows everybody to get the serum.

At the end of the movie Arrowsmith along with Gottlieb's assistant quit the medical research institute that had employed them, to work in an independent lab where they could pursue their research without influence from commercial interest.  In other words, they returned to the pure life that Gottlieb had championed.  In this way they honored Gottlieb.   Yet in my interpretation of the story, Gottlieb was not deserving of this honor.

No comments: