"A great deal of basic research has been done ... but I think the time has come to zero in on the targets — by trying to get our knowledge fully applied. ... We must make sure that no life-saving discovery is locked up in the laboratory."
—President Lyndon Baines Johnson, 1966
As director of the Montreal Neurological Institute and Hospital at McGill University, I spend much of my time discussing our research efforts with the public, and I am often struck by their perceptions about how breakthroughs are made in medical research. In this regard, not much has changed over the past 40 years.
Like LBJ, most people are of the opinion that scientists work in isolated laboratories, engaging in solitary studies whose results are jealously guarded. Most people are also frustrated with the pace and progress of research. If scientists would only focus on a specific disease target, collaborate more and communicate better with their colleagues, cures and therapies would tumble rapidly out of the lab and into the clinical arena. Why study irrelevant problems?
These notions reflect profound misconceptions about how discoveries are made and how scientists work. Contrary to popular belief, the vast majority of academic research scientists and clinicians are already quite focused, seek out collaborations with colleagues, and are eager to share their results. So why do the spectacular breakthroughs that we expect — vaccines against new infectious threats, cures for cancer, heart disease and neurological disorders — remain elusive? The answer is that they are not elusive, but only seem to be so; important discoveries are constantly in development. And what appears to be irrelevant today is often a crucial component of tomorrow's success.
We do not appreciate the colossal effort behind a truly revolutionary breakthrough. It takes the conjunction of many apparently unrelated observations and technologies to produce most breakthroughs, and they evolve over time — a long time, in most cases. Let me illustrate what I mean, using as a model an apparently sudden medical breakthrough, in vitro fertilization (IVF).
Today is the 28th birthday of the first "test tube" baby, Louise Joy Brown. Since her birth, about two million babies have been born worldwide whose mothers conceived by way of IVF. Today, "assisted reproduction" is routine, highly successful, and stunning in terms of what can be done for infertile couples.
The IVF story began with what seemed to be, according to the popular press, a well-planned, straightforward procedure carried out in Britain by gynecologist Patrick Steptoe and physiologist Robert Edwards in 1977. An egg was retrieved from Lesley Brown, fertilized in vitro, held in an incubator for a time, and then gently introduced into Ms. Brown's womb. On July 25, 1978, baby Louise was delivered by cesarean section. In some newspapers, it was noted in passing that, before her birth, the physician-scientists had carried out extensive, unsuccessful experiments for almost a decade.
By the late 1980s, IVF physicians and scientists established mastery over much of the reproductive process, and IVF birth rates were climbing. Multiple eggs in a woman's ovaries were pushed to maturation over a period of days using timed hormonal injections. As the eggs matured, they were monitored by ultrasound imaging, and the hormonal response measured by a highly sensitive technique called radioimmunoassay. Egg retrieval was also accomplished under ultrasound guidance, and the collected eggs fertilized in a lab dish. If necessary, eggs and/or sperm could be precisely "micromanipulated" to assist fertilization, and then introduced into the uterus.
