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Reading:3 8/15/07 3:36 PM Page 21 The question is how we get to universal healthcare. This is where Michael Moore and Sicko are so powerful. He demands we cure the problem by removing the toxin: insurance companies. Cohn, instead, ducks, and in doing so loses much of the importance that his book could have and should have had for the singlepayer system.Rather than argue where his arguments and heart seem to lead him, towards a single-payer system such as the onehe lauds in France, Cohn argues that a hybrid system might function just as well. Such a system would attempt to achieve universal healthcare through a mix of government and private insurers. In other words, almost exactly what we have now. This suggestion is mind-boggling—as if Cohn had not read his own book. He spends chapter after chapter detailing the way private insurers fail their patients and poison the healthcare environment, only to turn around and suggest that perhaps we should give them more customers and power over medical decisions, all in the name of achieving "universal" healthcare. At one point Cohn counsels us, "It takes hope to sustain the kind of movement necessary to enact sweeping policy changes." It seems he ran out of that hope. —shum preston The Demon Under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug by Thomas Hager. 340 pp., $24.95 I t's hard to imagine now, but as late as the 1930s, a simple strep throat, bout of pneumonia, an infected wound, childbirth, or case of bronchitis could quickly lead to death. With no antibiotics, healthcare providers of that time could do little more than observe and care for people suffering from bacterial infections, hoping and praying that their patients' immune systems would kick in and be strong enough to fend off these invaders. Tens of thousands of people around the world routinely died each year from infections, often in epidemics that swept through cities and hospitals. All of that changed with the discovery in 1932 of the world's first antibiotic: sulfa. In The Demon Under the Microscope, Thomas Hager does a masterful job of telling the complex, odd, and often serendipitous tale of the international team of doctors, chemists, and researchers who forever changed the landscape of medicine and society. Hager picks Gerhard Domagk as his protagonist, a German physician who was driven to find a "magic bullet" drug that would stop bacterial infection after witnessing the horrendous suffering of soldiers he treated in World War I, and who would ultimately win a Nobel Prize for his sulfa work. The timing was right for this type of research. Domagk went to work for Bayer, the German chemical manufacturing giant, right as it was adopting systems for industrial research on a scale never before seen or attempted. The researchers at Bayer, originally famous as a dye maker, knew that dyes would attach themselves to bacteria and thought that the dye could act as a vehicle for poisons. But beyond that, they were groping in the dark. Teams of chemists would create hundreds of chemicals every month, chemicals that tinkered with the molecular structure of dyes and attached side chains of various elements. Domagk would then methodically subject the chemicals to rigorous testing in laboratory animals infected with various bacteria. As the writer described it, the process was like trying to pick up a single grain of sand with a bullJ U LY | A U G U S T 2 0 0 7 dozer. The breakthrough finally came in 1932 when chemists stuck a side chain of sulfur to the dyes and achieved nearly miraculous results, curing infected animals with minimal side effects. What the Germans didn't realize at the time was that the dye had nothing to do with these chemicals' antibiotic effects; it was the sulfur—or more specifically sulfanilamide—itself. Eight years later, British scientists would learn that the sulfa molecule was structured and sized much like para-aminobenzoic acid (PABA), a chemical needed for bacterial metabolism, and worked by tricking bacteria into wasting its time trying to metabolize sulfa instead of PABA. It was the French who figured out that sulfa alone worked. The problem for the Germans, however, was that sulfa was a common and unpatentable compound (it had been used for years to make dyes on fabrics more colorfast) and they stood to make comparatively little money off it. As word got out, drug and chemical companies across Europe and the United States began in the mid-1930s churning out endless variations of sulfa, hoping to patent those that worked better than pure sulfa. While physicians across Europe were beginning to regularly use sulfa with spectacular results, it didn't take off in this country until 1936, when it saved President Franklin Delano Roosevelt's son from a strep infection. Then people began popping sulfa like crazy. But with no manufacturing regulations and little oversight, it also didn't take long for the first sulfa poisonings to kill consumers. In 1937, the Massengill Company sold an "elixir" of sulfa dissolved in diethylene glycol, a chemical solvent, which eventually killed more than 100 people. This tragedy led to the fast decline of the patent medicine industry, the passage in 1938 of the country's first modern food and drug safety laws, and the rise of the Food and Drug Administration. In the wrong hands, sulfa also factored in inhumane and gruesome experiments by the Nazis during World War II. Bayer's parent conglomerate, IG Farben, would also eventually produce a key chemical used in Nazi gas chambers. Even as sulfa was growing popular, though, it was also becoming obsolete. British researchers found penicillin in the late 1930s, an antibiotic that worked faster, with milder side effects, and on a wider array of infectious diseases than sulfa. Also, people took sulfa so indiscriminately that by the early 1940s, bacteria were showing resistance to it. Still, as Hager writes, "sulfa…kicked off a revolution in medicine," not only saving people who previously couldn't be saved, but also changing the way research was conducted, ushering in the modern era of "better living through chemistry," and leading to the ascendancy of doctors and drug companies. Ironically, the discovery of sulfa as an antibiotic cut short the "Golden Era" of public health efforts. Before these drugs, programs abounded to prevent infection before it started. Afterward, money was shifted toward developing new medicines and technologies. And this is Hager's final message, that there are no "miracles" in science. With every great discovery comes unintended consequences, a lesson for us all to remember. —lucia hwang W W W. C A L N U R S E S . O R G REGISTERED NURSE 21