Letters to the Editor

Abstract

LETTERS TO THE EDITOR Dear Sir: I found "Giants with Tunnel Vision," Theodore Schwartz's account of the Albright-Collip differences on the site of parathyroid action, illuminating and entertaining. Some of these issues were debated in a lively way during the fifties at the Macy Conference on Metabolic Interrelations, where Albright and his collaborators were among those attending. I recall being invited to one of these conferences, where I felt privileged and awed to meet Albright. It was sad to see that his disease had seriously disabled him physically. Earlier, Albright and Reifenstein had expressed the view that the "main action of the parathyroid hormone is on the phosphorus and calcium metabolism" [I]. Nevertheless, Albright was attentive to the shifts in nitrogen balance accompanying disorders in bone apposition, including lytic states. At that conference, with some youthful brashness, I reported work done in collaboration with H. R. Catchpole and N. R. Joseph on the mobilization of bone and connective tissue matrix proteins by parathyroid extract [2, 3]. This view was based on histochemical and physico-chemical studies of the ground substance of bone and of the kidney, together with determinations of a serum glycoprotein fraction (orosomucoid) and urinary levels of the Tamm-Horsfall carbohydrate-containing protein. The latter markers were elevated following hormone administration. These early results were extended by our students [4] and others to include derivatives of collagen degradation. Now, with the refinement of fractionation techniques and the ascendancy of reductionist thinking, a myriad of collagenous and non-collagenous proteins of bone and connective tissue are being measured in blood and urine and related to various physiologic and pathologic states involving bone. Both Albright and Collip focused on the electrolyte flow in target tissues. They barely considered the possible effect of parathyroid hormone on the lability of the matrices of bone and connective tissues. Was this also "tunnel vision"? REFERENCES 1.Albright, F., and Reifenstein, E. C, Jr. The Parathyroid Glands and Metabolic Bone Disease. Baltimore: Williams & Wilkins, 1948. 2.Engel, M. B.; Joseph, N. R.; and Catchpole, H. R. Equilibrium of calcium and other ions in connective tissue. Trans. Macy Conference on Metabolic Interrelations 5:105, 1953. Permission to reprint a letter printed in this section may be obtained only from the author. Perspectives in Biology and Medicine, 35, 4 ¦ Summer 1992 621 Engel, M. B.; Joseph, N. R.; and Catchpole, H. R. The effect of parathyroid extract on ground substance and calcium of bone. Trans. Macy Conference on Metabolic Interrelations 5:119, 1953. Migliozzi, J.; Catchpole, H. R.; and Engel, M. B. Connective tissue components in blood, urine, and bone following a massive dose of parathyroid extracts. Biochem. Med. 15:271, 1976. Milton B. Engel University ofIllinois College of Dentistry Chicago, Illinois Dear Sir: I must differ, however gently, with Dr. Engels suggestion that Fuller Albright 's lack of interest in the effect of parathyroid hormone (PTH) on bone matrix is another example of "tunnel vision" (Perspect. Biol. Med. 34:327, 1991). Albright was well aware that the administration of PTH was associated not only with the release of calcium salts from bone but also with the dissolution of bone matrix. Indeed, his views in this area provide another example of his prescience: "The first [theory], to which the authors incline, holds that the inorganic salt is removed from the matrix . . . and that the osteoclasts represent foreign body cells clearing up the debris of organic matrix" [I]. Dr. Engel, in effect, asks, "Should not Albright have extended his studies to include measurements of the products of dissolved matrix?" The answer probably lies in the fact that Albright, unlike Collip, was not an innovative laboratory worker; he relied on laboratory techniques, devised by others, to pursue his clinical investigations. Since he had access to no reliable measurements of matrix degradation during the period in question, he could not have pursued this line of inquiry. To fault him for such an omission would be unfair; one cannot be accused of "tunnel vision" when there is no tunnel. This is not to say, of course, that Albright was not a brilliant improviser at the bedside. From the inception of his career, he insisted that "Science, in the final...