Nobel Lectures: Physiology or Medicine 1996-2000

No prize for science carries as much cachet as the Nobel. Everyone has heard of it and small children dream that one day they may win it. Many of the major discoveries that have changed the way we practise medicine have been rewarded with the prize in Physiology or Medicine. Banting for the discovery of insulin (1923), Einthoven for the ECG (1924), Landsteiner for the discovery of blood groups (1930), Fleming, Chain and Florey for penicillin (1945), Cournand, Forssmann and Richards for cardiac catheterization (1956), Watson, Crick and Wilkins of course (1962), Cormack and Hounsfield for CT scanning (1979), Jim Black for his discovery of beta-blockers and H2 antagonists (1988) and John Vane for his work on aspirin and prostaglandins (1982). Others in retrospect, seem less obvious—Wagner-Jauregg's discovery of ‘the therapeutic value of malaria inoculation in the treatment of dementia paralytica’ or Grib Fibiger for ‘his discovery of the Spiroptera Carcinoma’. What is surprising is that despite the prize's importance to medicine and our work as doctors, and the huge publicity it receives each year, my questioning of a semi-random selection of medical students and junior doctors suggests that few are able to name the winners, identify discoveries that won the prize or put an approximate date to even the most famous of the discoveries. We forget where our profession owes its greatest debts. The book of Nobel Lectures (1996-2000) edited by Hans Jornvall is a joy. These are personal essays giving insight into the lives, careers and minds of Nobel winners. The reader can't help but try to identify the common strands—what makes a Nobel Laureate, what motivates them, which paths do they follow, and what part does luck play in the process of their discoveries? One thing we do know is that there are dynasties, with Nobel winners tending to beget other winners, or at least pedigrees of high-flying scientists connected through common laboratories. The beauty of scientific work of this calibre is often the simplicity of the questions: we know that proteins are being made all the time, how do they get to where they need to be (Blobel 1999); or why does acetylcholine relax blood vessels in an animal but not when you take the blood vessel out (Furchgott 1998)? Reading one or two of the Nobel Lectures seems to me a vital part of a doctor's training. To get a broader scope than the few lectures presented in this book, a visit to the Nobel website [http://www.nobel.se/] is worthwhile. This also gives you an opportunity to see whether you think you can spot which Nobel Prize discoveries are going to change the world, which are going to be forgotten, and which may even prove to be wrong in 50 years' time.