The OTHER Manhattan Project only made moral arguments rather than A-Bombs : but its impact has been immense

Moral conservatives such as today's American Republican Party frequently argue that morally medical care (such as expensive life saving drugs like Avastin) should only go to those who have worked hard enough to afford them.

They maintain this argument ( hello Obamacare !) even if this means that these drugs as a result of this limited market demand will remain in limited production forever and so be expensive forever.


The opposite moral argument (as made by Dr Martin Henry Dawson in his battle with the Allied governments in WWII) calls for the government to greatly expands the lifesaver's potential market by initially subsidizing the drug so that it available to all regardless of income, geography, race ,gender etc.

It is claimed this will encourage new producers to come in and try and find ways to compete with the established producer by lowering their production costs and hence ultimately reduce the price of the drug to the consumer.

Penicillin G provides the best possible example of this argument, proving the validity of this economical argument beyond all measure.

But greatly expanding the universe of people with affordable access to lifesaving Penicillin G also had an unexpectedly profound impact on the entire world's health.

Unusually cheap abundant public domain Penicillin G saved the lives of many people who are ordinarily too poor or in two remote regions to be treated and who thus remained reserve pools of highly virulent - and contagious - strains of the bacterial diseases that were endemic or epidemic worldwide for millenniums.

In a form of quasi Herd Immunity, billions of us (I estimate ten billion of us so far) have indirectly benefited when tens of millions of us directly had their lives saved by penicillin G shots.

Dangerously contagious bacterial diseases that terrified our grandmothers, that hung like the Sword of Damocles over all households rich or poor, are no more.

Those of us under the age of fifty have never even heard of most of them and few doctors practising today have even seen a single case of them.

The Big Manhattan Project made the A Bomb and made a huge array of massive buildings - it was big in every concrete sense of the word.

By contrast, the other Manhattan Project, that of Dr Dawson, only made moral arguments (and a little home brew penicillin) rather than Bombs or Buildings.

But who can save that this project's impact  - 75 years on - is not way, way bigger than that of the project headed by Robert Oppenheimer and Leslie Groves.... 

I'm today's go-to-expert on yesterday's battle over "penicillin-for-all" - by default

While I consider myself the world's leading expert on the wartime battle over the principle of penicillin for all, I also recognize I am also probably the only person in the world who gives a tinker's damn over that 75 year old battle.

A pity that.

Because there are still lessons for today in that old battle, particularly with regards to drugs now costing cancer patients $300,000 a year per person.

For when the wartime general public bested the scientific elites and Big Pharma over the principle of penicillin-for-all, it changed our whole world for the better, forever , in ways few then imagined.

Because penicillin remained totally in the public domain and now had the entire world's public loudly clambering for it, its cost fell quickly to record low levels for such an effective, safe lifesaver.

It was thus given to the poorest patient in the most remote parts of the world , people normally left untreated due to cost.

It thereby knocked out the traditional residual pools for virulent strains of bacteria that kept their names household scourges by remaining endemic or epidemic for millenniums.

Millions were directly treated by penicillin G to save their lives but billions of us indirectly benefited - free of charge ! - by a form of quasi-herd immunity.

As we move to rationing expensive drugs, let us ask ourselves if the example of the battle over wartime penicillin does not suggest a better way ...

Penicillin is not Avastin, but it could have been...

My book - The smallest Manhattan Project  - is about us , all 10 billion of us , here today or years dead, whose lives have been improved by the advent of inexpensive penicillin.

In a sense, this book is a rarity : one written from the patient's eye view of how that drug came to be ; a welcome change after decades of endless books exclusively devoted to how penicillin looked to the people who discovered and developed it.

Penicillin is frequently called the Miracle Drug but few consider that its biggest medical miracle was really in fact its cost, or rather 'lack of cost'.

Because the diseases that penicillin treats are contagious,  patients too poor to afford a cure remains a reservoir of the most virulent strains, waiting to infect the rest of us.

There actually were methods of preventing much of these diseases before the development of penicillin : they included the ready availability of good jobs, good food, cleaner and bigger homes, greater social respect.

Baring that, only the worldwide availability of a drug that would cure those diseases once they started up, at a price that almost all could readily afford , could reduce these diseases from being endemic or epidemic to just names in a dusty medical textbook.

That is why I can say, with absolute assurance, that even those of us who have never had a single treatment of beta-lactam (penicillin family) antibiotics are in better health today because the grandparent of them all, Penicillin G , is water cheap - literally a lifesaver "too cheap to meter" .

But it almost didn't happen , we almost lost "inexpensive penicillin".

We almost got an expensively patented synthetic drug more akin to Avastin and all those other $100,000 a year plus medications.

"The smallest Manhattan Project" is the story of a doctor ( himself slowly dying of another unrelated disease) who sacrificed his own health to see penicillin from the patient's point of view.

His name should be honoured for all time.

This, despite the fact that he did not discover penicillin and then neglect it (Fleming) nor did he start its re-discovery and eventual development, albeit while pursuing a pathway that nearly killed off that development (Florey).

Dr Martin Henry Dawson, for that was his name, merely said penicillin should be made available - now! - for every single patient whose life could be saved by it , even during the height of a Total War .

Nay, he went much, much further.

Dawson in fact said all should have access to life-saving penicillin, particularly in the middle of a Total War.

That was because that war was supposedly being fought against one opponent in particular, solely because that opponent's core philosophy said that 'some lives are more worthy than others'.

How could we continue to conduct that war with any moral vigour when our own medical establishment was 'me-tooing' Hitler's doctors ?

Now the mantra 'Penicillin for all who needed it regardless of their income level or skin colour' in the mid-1940s meant its mass production, given the vast amount of infectious disease endemic in those years.

And mass production has its myriad ways of driving production costs down, down , down --- as happily happened in the case of Penicillin G in almost textbook manner.

'Penicillin for all' quickly became 'inexpensive penicillin for all' and once that happened, penicillin began to work almost like the way a good public health vaccine program should work : the treatment of the many ultimately offering 'herd protection' to all the rest of us, free of charge.

Insulin is another drug frequently called a miracle drug.

But the sad fact is that it is far more common today than it was beforeinsulin was discovered, for a variety of reasons.

By contrast, the names of all those bacterial household scourges that so terrified our mothers and grandmothers are not even known to most of us under the age of 50, and most doctors practising today have never seen a case of them.

And that is just the sort of modern day miracle that Dawson's mantra of 'penicillin for all' can produce.

For the complex truth is that our choice of medical ethics has economic consequences and these in turn feedback and have medical consequences.

The case of what the mantra of 'penicillin for all' ultimately led to should be taught in every health economics and health ethics oriented university department for just those very reasons....

Lifesaving 'too cheap to meter:' the legacy of the smallest Manhattan Project

Remember that solemn pledge from the biggest Manhattan Project ?

After killing a few hundred thousand civilians overseas, they promised to make up for it by offering us endless, abundant, safe electricity at prices 'too cheap to meter'.

They were joking, right ?!

By contrast, consider the legacy of the smallest Manhattan Project.

It has offered us decades of lifesaving at prices 'too cheap to meter'.

That is an amazing feat considering it was performed against the combined resistance from the biggest of the wartime Allied  governments and from many politically powerful firms in wartime's Big Pharma.

Penicillin, more than 85 years after its initial discovery, still can stop cold the toughest bacterial infections going, and do so at prices dirt cheap, offering us true life saving at prices too cheap to meter.

Contrast that to today's to cancer drugs,  averaging at costs between $100,000 to $350,000 a year, that can only promise to extent the average life by about four months.

This is because natural penicillin was born in the public domain, born the original genetic drug , and Man failed totally to synthesize it and expensively patent it.

Penicillin is often called the miracle drug and perhaps its biggest miracle was economic, not medical : it could be given the opportunity to save hundreds of millions worldwide because it wasn't priced like Avastin but rather was almost as cheap as water.

(A real miracle - and I repeat, it almost didn't happen, we almost lost inexpensive penicillin.)

That was because our busy wartime Allied bureaucrats and busy wartime drug executives spent zillions in scarce tax dollars to try to synthesize and patent penicillin rather than getting down to doing Job One with readily available natural penicillin.

Their Job One and Two and Three should have been saving lives in a worldwide war crisis.

Henry Dawson's 'Penicillin-for-all' did not just mean making it available to all at a steep price, like Avastin : it meant making it available to all patients, at a price even the poorest can afford...