Some 3,800 doctors, specialists in internal medicine, convened in San Francisco last week to swap shoptalk on everything from bedside treatment to basic science. The occasion: the annual meeting of the American College of Physicians. The doctors posted no huge billboards announcing dramatic cures, but they set up a few small signposts pointing in hopeful directions. Items:
THE COMMON COLD. There is no hint yet of either a preventive or a cure for the common cold. Reporting for a University of Illinois team that has made thousands of tests on 2,500 volunteer cold-catchers, Dr. George Gee Jackson suggested that the idea that there is a specific common-cold virus, peculiar to man, had best be abandoned completely. No fewer than 70 viruses have been shown to cause human diseases that run the gamut from the simple common cold (runny nose and other discomforts, but usually no fever) to influenza. Most discouraging for snifflers awaiting a wonder drug: in some people, at some times, viruses of supposedly the relatively harmless, common-cold class may cause disease as severe as influenza, while the more feared influenza viruses may give rise to symptoms no more severe than those of the common cold.
And there are all kinds of intermediates.*
RHEUMATIC DISEASES. Ten years' experience has shown that hormones of the cortisone family, while giving temporary relief, often do as much harm as good in rheumatic diseases. But the Mayo Clinic's famed Dr. Philip S. Hench, pioneer (with Chemist Edward Kendall) in the extraction and use of these products, struck out on a bold new line. The natural pituitary hormone ACTH and the cortisone-type drugs, he said, must be viewed not only as remedies, but also as research tools. His new theory, based on observations of thousands of patients: it is neither a simple excess nor a simple deficit of adrenal hormones that triggers the onset or recurrence of rheumatoid arthritis and related diseases. It is, he asserted, a "turn of the tide"—a change in the circulating hydrocortisone from abnormally high to low levels—that does the damage.
In normal people, he said, the hydrocortisone output goes up sharply in the early morning hours to a peak around 6 a.m., then falls gradually to a nighttime resting level. In a rheumatoid arthritis victim, this pattern is generally reversed. Lacking adaptive ability, the patient reacts with a flare-up of disease when the cortisone tide ebbs. This may happen after delivery to a woman who has been free of arthritis symptoms during pregnancy. The letdown phenomenon is also seen in patients after long-term cortisone treatment.
Dr. Hench challenged his hearers with the defiant statement that they would probably be unable to accept his theory at this stage. But since he suggested that it applied, beyond rheumatoid arthritis, to several disorders such as rheumatic fever, gout, psoriasis and ulcerative colitis, he left them with much to ponder.