2003 Nobel Prize in Physiology or Medicine - - Revisionist History?





Ms. Powderly is Acting Director, Division of Humanities in Medicine SUNY Downstate Medical Center. Disclosure: Dr. Powderly is a clinical ethicist and historian of medicine at SUNY Downstate where Raymond Damadian did his MRI work.

On October 6, 2003, the Nobel Committee announced that Paul C. Lauterbur, PhD, an American chemist and Sir Peter Mansfield, PhD, a British physicist were the winners of the Nobel Prize in Physiology or Medicine for their work on the development of Magnetic Resonance Imaging (MRI). The MRI is widely acknowledged as one of the most important technological medical advances of the twentieth century and many felt that its recognition by the Nobel Committee was long overdue.

There has long been a controversy regarding the development of the MRI, however, and some felt that was what kept the Nobel Committee from acting earlier. Dr. Lauterbur, 74, is in declining health, however, and the Nobel Prize cannot be awarded posthumously. If the MRI was to be acknowledged, the time had come. The Nobel Committee took sides, if you will, in the controversy, when it did not name Dr. Raymond Damadian as one of the recipients of the prize.

There has been a rivalry between Drs. Damadian and Lauterbur for three decades. A review of the literature reveals that both played important roles in the development of the MRI we know today. Nuclear magnetic resonance had been a tool of physicists and chemists and had won the Nobel Prize for Physics in 1944 and 1952. The 2003 prize recognizes the medical application of magnetic resonance. It is important to understand the chronology of the events which contributed to the move from the chemistry or physics lab to the bedside and clinic in order to understand the current controversy.

Raymond Damadian was born and raised in New York City. He attended the University of Wisconsin, starting at age 15, on a Ford Foundation scholarship. He was a talented tennis player and violinist and could easily have chosen a career as either. He chose medicine, however, and graduated from the Albert Einstein College of Medicine. Although trained as an MD, he pursued a research career early on and joined the faculty at the SUNY Downstate Medical Center in Brooklyn. He wanted to make a difference for a lot of people and was particularly interested in conquering cancer, having experienced the agonizing death of his grandmother from breast cancer when he was a child.Dr. Raymond Damadian

Damadian first conceived of the idea of a whole body scanner in 1969. The following year he was able to use magnetic resonance to distinguish healthy tissue from cancerous tissue in mice. This made the idea of a scanner worth pursuing in his mind. Damadian's results were published in the journal Science in March 1971. He applied for a patent for his scanning method in 1972 and the patent was granted in 1974.

His was the world's pioneer patent in the field of MRI and the patent was upheld by the High Court on U.S. Patents and the U.S. Supreme Court in a case against General Electric in 1997. Damadian and his graduate students built, from scratch, the first whole body scanner in the labs at Downstate and achieved the first image of the human body in 1977. This scanner, named the Indomitable is now part of the permanent collection of the Smithsonian and is on loan to the U.S. Patent Office National Inventor's Hall of Fame. Damadian left Downstate in 1979 and founded the FONAR Corporation, a company which he still heads, to produce commercial MRI scanners. (Damadian rejoined the Downstate faculty in 1998 as Professor of Radiology and Medicine.)

Dr. Lauterbur, trained as a physical chemist and a chemistry professor at SUNY Stony Brook, was no stranger to magnetic resonance, although he may not have initially seen the implications for human imaging. In 1971, he observed a graduate student replicate Damadian's experiment. He concluded that the imaging method would not produce images which would be useful in locating and diagnosing tumors. He made a notation in his lab notebook recognizing Damadian's work, but proposing a different method of imaging, employing a second, weaker magnetic field that varied with position in a controlled fashion to create a magnetic field gradient.

Lauterbur would go on to produce the first image of a live subject, a clam, using magnetic resonance and published a paper in Nature in March of 1973. He neglected to refer to Damadian's work in his published paper, although he did include references which cited Damadian. Lauterbur would later say that he had a limit for his bibliography. While this did not seem to be an intentional oversight, Damadian would take it as such. Thus would begin an adversarial relationship that would go on for decades.

Lauterbur left SUNY Stony Brook in 1985 after the University of Illinois at Urbana-Champaign promised him improved lab facilities and a job for his wife. He remained there for the rest of his career as an academic exploring such abstract subjects as the chemical origins of life. The magnetic resonance instrument he used at Stony Brook was borrowed from other chemists. He would have to restore the settings each night so they would reflect the needs of his colleagues. That instrument is now on display in the Graduate Chemistry building at Stony Brook where he holds the position of Adjunct University Professor. Lauterbur's gradient method was adopted by Damadian in the early 1980s in the scanners he produced at FONAR.

In 1988, President Ronald Reagan awarded Drs. Damadian and Lauterbur the National Medal of Technology "for their independent contributions in conceiving and developing the application of magnetic resonance technology to medical uses including whole-body scanning and diagnostic imaging." On that occasion, Dr. Lauterbur is said to have offered his hand to Damadian who turned his back on him reflecting his feelings about their decades long adversarial relationship.

Scientific discoveries, such as those which are celebrated with Nobel Prizes, rarely, if ever, reflect the work of one individual. Scientists sometimes work together and often race against each other. Thus the Prize can be, and often is, awarded to more than one individual; in the case of the Nobel Prize, the number of awardees can not exceed three. The accounts of Drs. Damadian and Lauterbur reveal them both to be egotistical, driven scientists. Each believes they had, at minimum, an important, if not crucial role to play in the development of an extremely important technology.

The career paths they pursued after their early work in MRI were quite different. Paul Lauterbur is a career academic scientist. Raymond Damadian, a physician, was an outsider from the outset. He became more of an outsider when he became a businessman and pursued his rights in patent court. Some have even questioned his religious beliefs in relation to his scientific background -- he is a creationist who does not believe in evolution. He has also been driven, throughout his career, not only by the desire to make a difference for the human race -- perhaps by conquering cancer -- but also by the need to be acknowledged for his contribution. The ultimate recognition for such a contribution is the Nobel Prize.

It seems clear that Drs. Lauterbur and Mansfield made contributions to the MRI worthy of such acknowledgement. On the other hand, would they have pursued their important work leading to practical images of the human body had Raymond Damadian not established that normal and cancerous tissue would produce different images? Since the award could have been given to three scientists and was only given to two, not naming Damadian seems to be a serious and purposeful omission. Even the press release of the Chancellor of the State University of New York, Robert L. King, congratulating Dr. Lauterbur for winning the Nobel Prize acknowledges Damadian's work at the same university. Damadian, through his company, has taken out full-page ads in leading newspapers claiming he was wronged and asking supporters to contact the Nobel Committee. There is no official appeals process and the Committee has never changed awardees in previous controversial situations. The ads have evoked both intense criticism and support in the popular and academic press.

There are examples in Nobel history of precursor discoveries being included in the awards and there are other examples where seemingly logical discoveries were not acknowledged with an award. The deliberations of the Nobel Committee and the basis for their decisions regarding awardees remain closed for 50 years. Only then will the world know what contributed to their decision to leave Damadian out. Nobel Prize winners assume an elite place in the historical record, however, and Damadian is concerned that history will therefore not acknowledge his role. Nobel Prizes should be awarded for discoveries, not for personality or religious beliefs. If personality were a factor, Nobel himself might not have won his Prize. According to Peter Landers in the Wall Street Journal, Nobel, a successful businessman who made his fortune in dynamite, often got into patent battles and was a notoriously difficult man. Burton Feldman in The Nobel Prize reports that Nobel once said that friends are "found only among dogs, whom we feed with the flesh of others, and amongst worms, whom we feed with our own."

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