Martin Arrowsmith's clinical trial: scientific precision and heroic medicine.

Abstract

For a while, Martin Arrowsmith, the hero of Sinclair Lewis's 1925 eponymous novel1 – written in close collaboration with the scientist turned writer, Paul de Kruif – became the iconic image of a medical researcher, and a source of inspiration for generations of American medical students and young doctors.2 One of the central elements of the plot is a dramatic account of a trial of an anti-plague prophylactic during an epidemic on a Caribbean island. In all probability, the description of such a trial in an important novel (Lewis was awarded the Pulitzer Prize for Arrowsmith, although he declined it) favoured the diffusion of the concept of scientific testing of putative preventive and therapeutic interventions. It also popularized the idea of controlled clinical experimentation, while depicting it as a dramatic endeavour. Physician-scientists, Lewis's book proposed, need to overcome the natural tendency of physicians to try to provide immediate succour to sufferers seeking their help, and yet to be willing to expose the few to unknown risks for the greater benefit of mankind.3,4 Arrowsmith is an iconic image of scientist as hero, and the field trial an iconic display of his heroism.5