Chemotherapy by Design

In 1988 the Nobel Prize in Physiology or Medicine was awarded jointly to Sir James W. Black, Gertrude B. Elion, and George H. Hitchings ‘‘for their discoveries of important principles for drug treatment.’’ The abstraction of the award citation subsumed two distinct lines of research. Black’s work introduced the first members of what became new classes of drugs: beta-blockers used in treatment of cardiovascular and other conditions, and H2-blockers, used to treat acid-peptic disorders. Hitchings’ and Elion’s collaboration had yielded effective drugs for use in a remarkable variety of conditions, including cancer, gout, organ transplantation, malaria, and bacterial and viral infections. This chapter is a first approach to a description and analysis of what may be called the Hitchings-Elion research program, which spanned more than four decades by the time that the investigators received their Nobel award. Three aspects of the Hitchings-Elion program deserve particular emphasis: its coherence and unity across almost half a century of work that engaged a variety of collaborators; its embodiment of both rational and empirical elements; and its character as industrialized research. The close interdependence of these characteristics of the program may best be appreciated by tracing its course from its beginnings in the early 1940s through its various embodiments up to the eve of its recognition by the Caroline Institute in 1988.