This has to be one of my favourites examples of real medical innovation. All the hallmarks of one type of scientific and technological revolution are there. I have forgotten who first told me this story many years ago, not my brother the dentist I think, but an old school friend now in dental practice more likely, Dave Hudson. I was embarrassed not to have already heard of it, since I had already published a couple of papers related to how medical innovation works. This ranks up there at the top. Branemark, was an orthopaedic surgeon who, whilst researching healing, ‘noticed’ that titanium was not rejected by the body and integrated into bone, so much so that he could not remove it the end of his experiments into healing. The act of imagination, was to realise this provided a way to anchor artificial teeth. So, many of the key ingredients were there for a revolutionary discovery: he was an outsider, who the establishment rejected; the work was based on an original unplanned for observation (no project plan, or GANTT chart in sight); he did the experiments with his hands, so was in a position to make original observations; and the dogma of the day said it wouldn’t work (the arrogance of incomplete basic science strangling credible observations); and of course, his grants were rejected, so advance was delayed. Some quotes from the NYT flesh this out:
“To make sure that titanium would not be rejected by the body, Dr. Branemark enlisted about 20 students working in his lab to have titanium instruments inserted into their upper arms…..You have to understand, every male in the lab was considered a volunteer, including my older brother…
“Even after years of experimentation, though, it was difficult to convince the medical and dental establishment that titanium could be integrated into living issue. The conventional wisdom was that the introduction of any foreign material into the body would inevitably lead to inflammation and, ultimately, rejection.
“For years, Dr. Branemark’s applications for grants to study implants anchored in bone tissue were rejected…..
“Still, Dr. Branemark’s innovation was poorly received. After Dr. Branemark gave a lecture on his work in 1969, Dr. Albrektsson recalled, one of the senior academics of Swedish dentistry rose and referred to an article in Reader’s Digest describing Dr. Branemark’s research, adding, “This may prove to be a popular article, but I simply do not trust people who publish themselves in Reader’s Digest.” As it happened, that senior academic was well known to the Swedish public for recommending a particular brand of toothpick. So Dr. Branemark immediately rose and struck back, saying, “And I don’t trust people who advertise themselves on the back of boxes of toothpicks.”
Now, of course, implants have found many other medical uses, and Branemark worked on these ideas too: great ideas are generative. Surgical innovation is, in my opinion, harder than in many other areas of medicine, so it needs nurturing even more carefully. As Goldstein and Brown have said, the danger is that medics move into apparently fast moving areas of biology, the ones where you can buy the kits to do the ‘necessary’ bench work. Revolutions are harder, and require ever greater nurturing. Thank God he didn’t work at Imperial or Warwick medical schools.
[image CC BY-SA 3.0 David Shankbone http://en.wikipedia.org/wiki/Permanent_teeth#mediaviewer/File:Teeth_by_David_Shankbone.jpg]