|drawing by Suzanne Dunaway
For all of 1980, when my Roman medical practice was just getting under way, the lire barely trickled in and my ex and I were living hand to mouth. It was a godsend when I landed a half-year paid internship on Professor Cosimo Prantera’s gastroenterology ward – $190 a month may have been slim pickings, but it helped keep our plates full of pasta.
Professor Prantera’s specialty was Crohn’s disease, a serious and potentially fatal inflammatory condition of the intestine, and part of his standard treatment was a strict no-residue diet. Fruit-and-veg loving Italians were forced to buy centrifugal juicers so they could consume their peaches and their spinach in liquid form.
This amazed me. My medical school alma mater Mount Sinai, in New York, happened to have been where Dr. Burrill B. Crohn had first described the disease in 1932, and it was still the world’s foremost treatment center. At Mt. Sinai, Crohn’s patients were allowed to eat anything they wanted.
When I pointed this out Prantera replied, “In my opinion, fiber puts strain on the sick bowel. Prove me wrong.” I searched the medical journals (not an easy task, back in those pre-Google days), and found to my surprise that nobody had ever studied the issue. So a month later there I was, randomizing patients to normal versus low-residue diets to test it scientifically. I had been launched on a research career by sheer pigheadedness.
With Cosimo backing me up, it was easy. Between medical staffers with time on their hands and young volunteer doctors eager for brownie points, I succeeded in assembling a terrific research team with zero funding, spent three years slaving over it gratis, and managed to get our results – which proved the Mount Sinai docs basically right – published in a prestigious journal with a wonderful title: Gut.
My interest in research then evaporated until six years later, when my first marriage broke up and I needed to find ways to fill up my time and my brain if I was to keep my sanity. Dr. Prantera was happy to support me, saying that this time I could choose any topic I wanted as long as the gastroenterology ward patients would be appropriate guinea pigs. As an ex-wannabe-psychiatrist I decided to go for the psychosomatic angle, figuring it would be a cinch. After all, we had plenty of ulcer patients on the ward, and “everybody knew” ulcers were due to stress.
Who could have guessed that the Helicobacter pylori bomb was about to explode? By a year after I started my first ulcer study, “everybody knew” ulcers were due to Helicobacter infection, and the whole stress concept had been tossed in the trash because doctors couldn’t keep two causative factors in their minds at once. It seemed to me at the time that this was probably simpleminded, and by now I think I've proved it so.
Doing research kept my mind alive and my toe in public medicine, so I had no problem working pro bono. The research assistants contributed free legwork to further their game plan of worming their way into a real job. A statistician I’d met at a party volunteered his time out of friendship, the staff docs helped because they were told to, and the ward psychologist, whose usual gig was as a counselor, was more than glad to come on board. Everyone’s generosity was fortified by the promise of publications to fatten their CV’s. In the States I'd have never wriggled my way into medical research that way; there if your grant funding falls through you pack up your marbles and go home. If a study does get accomplished on the cheap, its results may even be considered a bit suspect.
For all but three of my 18 research years at the Nuovo Regina Margherita no money changed hands, and when we did have a brief flurry of funding it came not from Italy but from the US. I found out that the American National Institutes of Health would finance foreign research, filed an application, got turned down, applied again, and kept reapplying until I managed to win a grant. It started small and was reduced to peanuts by the Italian 20% inflation rate, but for us it was manna from heaven.
After my NIH grant had been approved and needed only a rubber stamp from the local health council, the whole project nearly got squelched: the councilors couldn’t believe we had gotten the grant without paying somebody off, and were petrified that if they gave the project their imprimatur they’d wind up in handcuffs. In a period where a Supreme Court justice was notoriously in the pay of the Mafia, they could hardly be blamed for seeing corruption behind every tree.