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THIS YEAR’S NOBEL PRIZE IN MEDICINE.
A PERSONAL LETTER TO MY FELLOW MEDICAL DOCTORS
ABOUT THIS SHAMEFUL WRONG
Dear Fellow M. D.,
Ever since I looked at the Web site of the Nobel Prize one
day at 5:30 in the morning, the time I knew the announcement
about the award for medicine would be posted, and was affronted
by my inconceivable exclusion from recognition for the MRI,
I’ve had a multitude of thoughts, not only of the wrong
done to me, but of you, my fellow medical doctors.
I considered addressing you about the sad event and my public
response to it in The Journal of The American Medical
Association, but, since it is a monthly, there would
be no time to prepare the printed piece and schedule it for
publication. So I have decided to set aside one of the printed
appeals we have been making to right this shameful wrong just
to have a talk with you.
First, I hope you understand that my appeal is soundly based.
If you would like any information to verify it, many medical
books – not to mention the High Court on Patents and
the U. S. Supreme Court - indeed agree that I am the discoverer
of the tissue signal differences (T1 and T2) that all MRI’s
today use to produce images of diseased and normal tissue.
I remember as if it was yesterday
when I, as a young medical doctor a bit out of his element,
got hold of an NMR (the original name for MRI) machine to
perform the experiments that would prove that life-saving
signals existed that would henceforward put NMR in the service
of medicine, not just the analysis of inert chemicals and
substances.
I decided on cancer tissue because I suspected I would meet
with skepticism about the medical application of magnets and
knew I needed a cause with a promise so great – the
alleviation of suffering from the agonies of that mortal disease
– that my critics would be less likely to be able to
obstruct an M. D. in the world of the research lab. I also
chose cancer because of the distress I had experienced in
more than one instance when, as a medical student and then
as a house officer, I would arrive at the autopsy table to
find a patient riddled with cancer that no one in the clinic
suspected the presence of. There was simply no machine that
could have seen it. The impediment was the X-ray’s fundamental
inability to visualize the vital soft tissues of the human
body.
In some earlier test-tube NMR experiments with other samples
I had begun to wonder if NMR might hold the answer and be
transformed from the relatively tiny instrument it had always
been – with an opening of less than two inches, into
which to insert the test-tube sample for analysis –
to a full-body scanner, which I would eventually have to build
by hand, in an abandoned laboratory at Downstate Medical Center.
I wish you could have been there with
me in those summer weeks of 1970 when I measured the
NMR signals from cancers and normal tissues and saw how dramatically
different they are. I discovered, for example, that the signal
decay-rate (relaxation time) of hepatoma is 826 milliseconds,
compared to the signal decay-rate of normal liver tissue at
293 milliseconds – a whopping difference of 182%. Now,
imagine! I knew all X-rays of soft tissue differences –
by CT, mammography, or fluoroscopy – were maximally
4%.
Yet how right I was about the reaction I feared might lie
ahead. A swarm of detractors, usually from the NMR specialist
club of Ph.D. chemists and physicists, immediately branded
my fragile proposal of an NMR body scanner as – to quote
one of the more offensive and less-prescient broadsides hurled
at me – “visionary nonsense.” As you might
guess, that sort of pervasive negativism had an exceedingly
damaging effect on my ability to raise the funds I desperately
needed to build a prototype. Out of desperation, two of my
graduate students and I built the first human scanner by hand
with spare parts.
We obtained the first human scan in
the early morning hours of 7/3/77. I still have a picture
of it, and it’s a beauty! I would not have guessed that
one day that handmade scanner would find its way into the
permanent collection of the Smithsonian Institution. Yet it
is the scanner that proved NMR held, not only some, but vastly
unprecedented potential for visualizing the human body.
THE MRI IS AN MD’s INVENTION
I want you to know something, and I want you to be very proud
of it. The MRI is emphatically an M. D.’s invention.
Although the two Ph. D.’s who have been named for the
prize – one a chemist and the other a physicist –
made later contributions to MRI technology, as have many others
since then, there is no way, outside of outright deception,
to ascribe primary credit for the invention of the MRI to
two scientists who merely imagined improved ways to display
the image of the signals I discovered. Countless Ph. D.’s
had been working with NMR for over 25 years without the idea
of a possible medical application ever occurring to even one
of them. It’s just not the way they think or are trained
to think.
Always be proud that, in the
coveted world of high-tech equipment:
An M. D. saw the need of mortally afflicted patients.
An M. D. proposed an NMR body scanner for the first time
ever.
An M. D. proved the NMR signal could detect a mortal disease,
the landmark discovery that proved the scanner was possible.
An M. D., together with his students, built the first MRI
scanner and achieved the first live human scan.
An M. D. used the scanner to obtain the first MRI picture
of patients with cancer.
Yes, my colleagues, an M. D. provided the first invention
ever of a scan method to achieve the early detection of cancer.
What’s more, that M. D. even had the temerity to patent
his invention, so he could have some chance of getting the
still much vilified machine out into the world, where it could
start to do the great good of which he knew it was capable.
By contrast, the two NMR specialists the Nobel Committee
for Physiology or Medicine has decided to honor for “discoveries
concerning the invention of the MRI” – the Ph.
D’s Paul Lauterbur and Peter Mansfield, along with literally
thousands of other research scientists – had been working
with NMR machines for 25 years (1945-1970) without one of
them ever asking himself if NMR might have a medical application,
let alone if the diminutive magnet-gap for test tubes could
be imagined as a full-body scanner, and then knowing which
experiments to perform to validate its promise.
Imagine now all of those wasted years of NMR’s possible
benefit to humanity, quietly waiting for an M. D. to encounter
the technology and realize its possibilities for scanning
patients.
The simple truth of history is that an M. D. was required
to recognize the usefulness of NMR to medicine and to perform
the experiments to demonstrate its greatest value.
Therefore, I believe it is outrageously unjust
that the Nobel should decide to exclude from its award the
M. D. genesis of MRI.
And I am not the only missing M. D. in this blighted picture.
We are all the missing M. D.’s.
How little did I realize when I made my discoveries that
I’d have to be “indomitable” at this late
stage in my life. Back then we chose “Indomitable”
as the name for the first scanner in an attempt to overcome
the skepticism and outright scorn that was heaped on our efforts,
ridicule that increased in volume to a startling degree when
I proposed an NMR machine that would be big enough to insert
a human body into.
My report of the abnormal NMR cancer signal and my first
proposal of the scanner was published in the journal Science
in March of 1971. Today, every MRI produces an image –
and can only produce an image – by recording and displaying
the marked differences in the signal strengths from cancerous
tissue and normal tissues that I discovered and reported.*
I wish you could have also been there when my struggling
little company arrived at the first hospital, one in Long
Island, that had the foresight to order our first commercially
produced machine. We had quite a time getting it into practical
service for patients, but we did it! And I am proud to say,
for all of us in the medical profession, that since my original
experiments, more than 500-million patients have been scanned
throughout the world, using the technology I discovered and
then implemented.
Yet the Nobel Committee for Physiology or Medicine has chosen
to ignore those signal discoveries and achievements. Since
my first appeal, the Nobel Assembly, who are advised by the
Nobel Committee for Physiology or Medicine, have lamely announced
that they are giving the award for “the image only.”
They certainly know how to compound the wrong with a second
dose of ignorance.
The MRI image is only there because
it is recording the difference in the signals I discovered
between cancerous tissue and normal tissue, as well as the
differences between the normal tissues themselves.
As you know, cancer tissue shows up bright (for example,
T2 images) on MRI scans because of its strong signals and
the surrounding normal tissue shows up much darker because
of its weaker signals. The contrast of the two signal types,
strong and weak, sets off the cancer dramatically, so it is
easily detected on MRI pictures and rarely missed, unlike
the condition that existed with the X-ray for almost 100 years.
Why have I been excluded? After
all, the award in medicine allows for three winners. Yet the
Committee chose only to name two and exclude the third. I
believe the reason is a cause for grave concern among M. D.’s
everywhere. It is not the first time a medical doctor has
been excluded for his technological achievement. My friend,
William Oldendorf, M. D., who did truly invent the CT Scanner,
and shared the Lasker Prize with the Nobel winner, was also
excluded from the Nobel Prize. I called him then to console
him. He responded, in words I now recall with especial poignancy,
with the heartfelt sigh, “They could have given it to
three.” Sometime afterward when I asked him how he had
fared in the wake of his exclusion, he answered, “What
can I tell you? Within six months of the announcement, I had
a triple bypass.” Not very long thereafter he died,
severely depressed and brokenhearted.
Now, the same wrong has been done to me, another M. D. But
don’t worry. I’m not going to die over the dastardly
wrong. I expect that I am sufficiently resistant to the mortal
slings of a prize process that has allowed itself to be dominated
by individuals who, regrettable as it is to acknowledge, are
ethically and intellectually corrupt. I cannot, however, sit
by and permit the illegitimate celebration of a disgrace to
my invention and its distinguished history. I am still determined
to live in the service of the MRI. I also realize I am the
first blatantly wronged scientist to call these arrogant scoundrels
to the high standards they espouse, rather than to fade away
into the oblivion they prefer for their victims.
I want to ask, What is the sorry track
record of the Nobel selection process symptomatic of?
The regrettable truth is, the process in Stockholm has fallen
victim to influences that have nothing whatever to do with
the truth of science. It has, in fact, fallen victim to considerations
that are a woeful vitiation of the unbiased evaluation of
scientific merit.
In the medical technology area especially, the process has
been hijacked by advisors who are determined to reserve the
research award for Ph.D.’s, in my case, Ph. D’s
who are NMR specialists. We know because we know some of these
scandalously prejudiced and, I might add, ill-equipped advisors
and because good friends of ours know others. Of course, many
Ph. D.’s are dear friends of mine and have always been
eminently fair-minded about what they know I have done; I
want them to be certain that I am not for a moment including
them in the political chicanery that has infected the Nobel
process. I am, in fact, proud to say that many exemplary Ph.
D.’s have voiced their outrage at my shocking exclusion.
What is the cure? I think the
whole clubhouse of Nobel insiders need many thousands of us
to let them know, in no uncertain terms, that all consideration
of values other than the truth of science has no place in
the prize process and, in fact, does more harm to science
itself than anything else one can imagine. We need, if you
will, to write a prescription for these calculating rascals:
“Sig. Truth, daily. Maximum
strength.”
I hope you wish me well in this unanticipated and unwanted
struggle upon which I have embarked. I realized after I was
excluded – during a difficult weekend I spent coming
to terms with the incongruous fact – that the Committee
was making a blatant attempt to rob me of my life’s
work and of my very identity, which for 33 years has been
centered around an all-absorbing dedication to creating MRI
machines and advancing their technology for the benefit of
our patients.
What do I hope to achieve? The
best that can be achieved. My goals are clear. I will do my
best to help right the shameful wrong that has been done by
letting the prize committee know, in a public forum, that
they are answerable for their malevolent decisions. The world
has now grown too small to offer a serene hideout for wrongdoers
who seek to occupy a global stage. I also hope by my efforts
to reduce the possibility that the Committee will wrong or
discourage other present and future M. D.’s who find
their calling in medical research and are partly inspired
by the normal human hope for recognition of their achievements.
Finally, I believe that, to the extent I am able to succeed,
a much-needed purging of the decision-making process for the
Nobel will have taken place. Thus I will have left it a more
worthy and honorable prize than the one by which I have been
wronged.
Now I ask you to help me rally the medical community to put
the Nobel Committee for Physiology or Medicine on notice:
Either put the truth of science first or get out of science.
We M. D.’s are 650,000 voices
strong in the U.S. Can you please let these would-be
intellectual pickpockets hear from you in the interest of
all M. D.’s, so they get the idea that this time they
can’t get away with their outrageous manipulations?
If you would like to let your voice be heard in this matter,
here is the contact information: The Nobel Prize Committee
for Physiology or Medicine, Nobel Forum, Box 270 SE –
171 77 Stockholm Sweden. E:Mail to: secr@mednobel.ki.se.
Or call the Committee at 011-46-8-585-823-44, 011-46-8-662-64-31
or 011-46-8-51-77-45-00.
A bit of advice. The Nobel Web site has been down recently.
Perhaps, the secretive culprits have just decided to tune
out the widespread outcry their injustice has, we know, provoked.
The current excuses we hear and read from their spokespeople
seem to indicate they have realized that their decision has
been shorn of any semblance that it was based on the truth
of MRI history. They have also, it seems, discovered that
assaulting my supposedly feisty personality as a reason for
my exclusion is an unacceptable way to justify their wrong.
But I admit I do get – understandably, I think –
exceedingly upset when I realize, once again, that some unconscionable
scientific pilferer is trying to steal my entire life.
We have noticed that they have
recently marshaled all that is left to defend the indefensible
error into which they have allowed this year’s Nobel
for Medicine to have fallen victim. It is a cold listing of
bureaucratic trifles, sputtered about their inviolable statutes,
which, we note, they change at will – a regrettable
litany which they sent off in response to a high-minded scientist,
whom I never met, who copied me on a letter he wrote the Assembly,
urging the members to return to the high standard of scientific
truth from which they have so maliciously plunged. He also
sent along the response he elicited. Here’s a distasteful
morsel: “Please let us inform you about our rules and
work…. The answer is that our statutes state that the
decision obtained from our voting meeting is final and without
appeal. Hence, this year’s award is final, the protocol
signed, and the case closed.” What utter, unworthy bureaucratic
nonsense they resort to. Decide to destroy a man’s life’s
work and then declare, with accountability to no one, “Case
closed”! Apparently, the light of truth has exposed
their violation of MRI history.
What person, worthy of the distinction
of being considered a scientist, who, when confronted
with evidence that proves he is indisputably in the wrong,
persists in his error? Yet, so far, that’s apparently
the case in Nobel land as of November 3, 2003.
Let me conclude by thanking you for taking time out in your
undoubtedly busy schedule to read my letter. But what else
have we physicians known in our lives but caring for and healing
the sick, all too often to the point of exhaustion, and, at
the very least, according to our oath, to “do no harm”?
Do you know what time I achieved the world’s first
MR scan of the human body? At 4:45 in the morning. Obviously,
we were working late. Yet, dear fellow M. D., what other life
would any of us want?
Cordially,
Raymond Damadian, M. D.
Paid for by Friends of Raymond Damadian Contact DanielCulver@aol.com
or call him at 631-694-2929.
* Strong signals mean bright pixels on T2 images and weak
signals mean dark pixels. The signal strength S is given by
S=k (e exp-TE/T2) for a T2 image; thus the longer the T2,
the stronger the signal (for a given TE).
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