I am confident this is the most memorable article ever from the British Journal of Urology

Full access here. This is certainly worth reading all the way to the end…. can’t help but wholeheartedly agree with the author’s conclusion.

How (not) to communicate new scientific information: a memoir of the famous brindley lecture

In 1983, at the Urodynamics Society meeting in Las Vegas, Professor G.S. Brindley first announced to the world his experiments on self‐injection with papaverine to induce a penile erection. This was the first time that an effective medical therapy for erectile dysfunction (ED) was described, and was a historic development in the management of ED. The way in which this information was first reported was completely unique and memorable, and provides an interesting context for the development of therapies for ED. I was present at this extraordinary lecture, and the details are worth sharing. Although this lecture was given more than 20 years ago, the details have remained fresh in my mind, for reasons which will become obvious.

The lecture, which had an innocuous title along the lines of ‘Vaso‐active therapy for erectile dysfunction’ was scheduled as an evening lecture of the Urodynamics Society in the hotel in which I was staying. I was a senior resident, hungry for knowledge, and at the AUA I went to every lecture that I could. About 15 min before the lecture I took the elevator to go to the lecture hall, and on the next floor a slight, elderly looking and bespectacled man, wearing a blue track suit and carrying a small cigar box, entered the elevator. He appeared quite nervous, and shuffled back and forth. He opened the box in the elevator, which became crowded, and started examining and ruffling through the 35 mm slides of micrographs inside. I was standing next to him, and could vaguely make out the content of the slides, which appeared to be a series of pictures of penile erection. I concluded that this was, indeed, Professor Brindley on his way to the lecture, although his dress seemed inappropriately casual.

The lecture was given in a large auditorium, with a raised lectern separated by some stairs from the seats. This was an evening programme, between the daytime sessions and an evening reception. It was relatively poorly attended, perhaps 80 people in all. Most attendees came with their partners, clearly on the way to the reception. I was sitting in the third row, and in front of me were about seven middle‐aged male urologists, and their partners in ‘full evening regalia’.

Professor Brindley, still in his blue track suit, was introduced as a psychiatrist with broad research interests. He began his lecture without aplomb. He had, he indicated, hypothesized that injection with vasoactive agents into the corporal bodies of the penis might induce an erection. Lacking ready access to an appropriate animal model, and cognisant of the long medical tradition of using oneself as a research subject, he began a series of experiments on self‐injection of his penis with various vasoactive agents, including papaverine, phentolamine, and several others. (While this is now commonplace, at the time it was unheard of). His slide‐based talk consisted of a large series of photographs of his penis in various states of tumescence after injection with a variety of doses of phentolamine and papaverine. After viewing about 30 of these slides, there was no doubt in my mind that, at least in Professor Brindley’s case, the therapy was effective. Of course, one could not exclude the possibility that erotic stimulation had played a role in acquiring these erections, and Professor Brindley acknowledged this.

The Professor wanted to make his case in the most convincing style possible. He indicated that, in his view, no normal person would find the experience of giving a lecture to a large audience to be erotically stimulating or erection‐inducing. He had, he said, therefore injected himself with papaverine in his hotel room before coming to give the lecture, and deliberately wore loose clothes (hence the track‐suit) to make it possible to exhibit the results. He stepped around the podium, and pulled his loose pants tight up around his genitalia in an attempt to demonstrate his erection.

At this point, I, and I believe everyone else in the room, was agog. I could scarcely believe what was occurring on stage. But Prof. Brindley was not satisfied. He looked down sceptically at his pants and shook his head with dismay. ‘Unfortunately, this doesn’t display the results clearly enough’. He then summarily dropped his trousers and shorts, revealing a long, thin, clearly erect penis. There was not a sound in the room. Everyone had stopped breathing.

But the mere public showing of his erection from the podium was not sufficient. He paused, and seemed to ponder his next move. The sense of drama in the room was palpable. He then said, with gravity, ‘I’d like to give some of the audience the opportunity to confirm the degree of tumescence’. With his pants at his knees, he waddled down the stairs, approaching (to their horror) the urologists and their partners in the front row. As he approached them, erection waggling before him, four or five of the women in the front rows threw their arms up in the air, seemingly in unison, and screamed loudly. The scientific merits of the presentation had been overwhelmed, for them, by the novel and unusual mode of demonstrating the results.

The screams seemed to shock Professor Brindley, who rapidly pulled up his trousers, returned to the podium, and terminated the lecture. The crowd dispersed in a state of flabbergasted disarray. I imagine that the urologists who attended with their partners had a lot of explaining to do. The rest is history. Prof Brindley’s single‐author paper reporting these results was published about 6 months later [1].

Professor Brindley made a huge contribution to the management of ED, for which he deserves tremendous gratitude. He was a true lateral thinker, and applied his unique mind to a variety of problems in medicine. These include over 100 publications that focus on the areas of visual neurophysiology and several other aspects of neurophysiology, including ejaculation and female sexual dysfunction. He also published one remarkable paper studying the effect of 17 different drugs used intracorporally to induce erection [2]. Seven of these (phenoxybenzamine, phentolamine, thymoxamine, imipramine, verapamil, papaverine, naftidrofury) induced an erection. It is not clear to what degree Brindley’s own penis served as the test subject for these studies.

This lecture was unique, dramatic, paradigm‐shifting, and unexpected. It is difficult to imagine that a similar scenario could ever take place again. Professor Brindley belongs in the pantheon of famous British eccentrics who have made spectacular contributions to science. The story of his lecture deserves a place in the urological history books.

Review of “Take Me To The Source: In Search of Water” and “The Blue Death” – TLS, 2008

Apologies for the hiatus. This is my submitted copy rather than the review as it appeared in the TLS. I re read most of Rupert Wright’s book a few years ago. This was the first time I came across the concept of water charges, which seemed to strike everyone else in Ireland as something completely out of this world in late 2013. I greatly preferred Wright to Morris and found his debunking of the “the world’s next war will be over” idea (I nearly typed meme!) convincing.

Take me to the source: In search of water. Rupert Wright

The Blue Death: Disease, Disaster and the Water We Drink. Dr Robert D Morris

Thales of Miletus, the earliest identifiable philosopher and scientist (in a fairly loose sense of both terms) held that “everything is water.” That this is the first philosophical and first scientific statement is no accident; water is central to human existence. In the West, however, the words of Jake Gittes in “Chinatown” are apt – “I turned on the faucet, it came out hot and cold, I didn’t think there was a thing to it. “Rupert Wright, who has previously written books about life in the Languedoc region, begins his discursive, digressive, suitably elusive book with the sudden cessation of water supply in his French home. When he bought the place, the fact that it came with its own water supply was another romantic touch. Only when it stopped did he realise that there was indeed “a thing to it.”

Wright has written an entertaining tour of the world of water, if such a tautology is possible in a world that is mainly water. From the gigantic excavation of a third water supply tunnel for New York, happening almost invisibly to passers-by in Midtown Manhattan, to asommelier instructing bored Parisians in the appreciation of spring and mineral water, to the hunger-striking Bishop of Barra in Brazil trying to stop the damming of the São Francisco River, humanity’s relationship with water is by turns inspiring, absurd, and tragic.

Water policy is steadfastly unsexy. All over the world, Wright notices, oil ministers are Harvard-educated, Rolex-wearing, Armani-clad; water ministers wear cheap suits and use their mobile phones to tell the time. Wright is no reflex contrarian, but his scepticism about some of the received wisdom about water and water policy is bracing. One truism of bien pensant opinion he  seems wearied by is the wars of the coming century will be a fought over water, a notion he imagines Flaubert consigning to a contemporary Dictionnaire des Idées Reçues. Only one war, he writes, has ever definitively been fought over water – “more have been fought over salt.” Water has been a tool of war rather than a cause of war, and the need for water drives co-operation as much as competition (Europe’s oldest law court the Tribunal de las Aguas de la Vega de Valencia, consists of eight magistrates who have convened every Thursday at midday since the Tenth Century to ensure the fair distribution of Turia River water.)

Wright is much more interested in how writers and artists have described and depicted water. Poetry flows throughout. He is particularly enraptured by the single flowing sentence that is Bloom’s reflection on water in Ulysses. That dry systemiser Stephen Dedalus disliked bathing and suspects ‘aquacities of thought and language’; hydrophilic Bloom boils the kettle and embarks on an epic sentence of reverie and connection about water. Three other texts especially inspire Wright – John Cheever’s “The Swimmer”, Roger Deakin’s “Waterlog” and Charles Sprawson’s “Haunts of the Black Masseur: The Swimmer as Hero” and he has something of the ruminative charm of Deakin and the digressive erudition of Sprawson.

No mention of Ulysses in Dr Robert D. Morris’ “The Blue Death” (Morris, incidentally, uses his professional title on the book’s cover.) While Rupert Wright does not gloss over the lethality of water-borne infections and the mass misery and death that can be caused by consuming water, Morris, a public health physician and water researcher, focuses exclusively on water-borne threats. Water, as a substance itself, is not centre stage – indeed is hardly mentioned. An aside that “safe water is not an end, but a process, an ongoing struggle in which improvement is always possible and often necessary. Purity, it turns out, is fleeting” is the closest we come to the philosophical reflections of Wright.

He begins with the tale of John Snow and the Broad Street pump. Snow is to epidemiologists what Indiana Jones is to archaeologists, and Morris lays of the suspense a little thick: “Snow felt he was finally closing in on the proof that might muffle his critics. The ground itself would need to shake to divert his attention from the task at hand. He would soon discover that an epidemiological earthquake like no other had its epicenter on the north side of the Thames.” We move on to the battles over cholera of Robert Koch and Louis Pasteur (“like seasoned gunfighters, they would meet in the streets of Alexandria with test tubes blazing until only one man was standing.”)

The tone shifts suddenly halfway through. Morris is no longer describing the heroic age of epidemiology and public health, but is centre stage. A meta-analysis he performs linking  long-term consumption of chlorinated water with cancer earns him the suspicion of the water treatment industry and, it seems from his own account, the Environmental Protection Agency. Again we are reminded that water is “unsexy” – public attention, for Big Water, means bad news. Outbreaks of cryptosporidium in Milwaukee in 1993 and E. coli 0157:H7 in Canada in 2000 illustrate the weaknesses of water processing systems that have changed little in a hundred years. Morris is no neutral in these matters, and closes the book with an eight point plan for ensuring safe water (step 7, by the way, involves the universal use of point-of-use filtration for drinking water.)

Wright writes ruminatively, philosophically, sub specie aeternis,, while Morris is the researcher in the arena of current controversy and impatient with the slow pace of change. Wright is amusedly tolerant of bottled water and its attendant absurdities; Morris is angered by a fad whereby more water is used to produce the bottle than goes inside. Both aim to reveal the truth about the ubiquitous and invisible substance that we are learning not to take quite so much for granted – water is everywhere, water is eternal, water is indestructible, and water is scarce, fleeting, and fragile.