cover of episode A Leap of Faith From the Eiffel Tower

A Leap of Faith From the Eiffel Tower

2022/9/23
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Cautionary Tales with Tim Harford

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Tim Harford: 本集节目探讨了两个案例:裁缝Franz Reichelt为了测试他的新型降落伞服,从埃菲尔铁塔跳下进行自我实验,最终不幸身亡;医生Barry Marshall为了验证幽门螺杆菌导致胃溃疡的理论,也进行了自我实验,最终获得成功并获得诺贝尔奖。这两个案例引发了对自我实验的伦理和风险的讨论,以及在科学探索和商业利益驱动下,自我实验的动机和结果的复杂性。节目还回顾了历史上其他医生的自我实验案例,有的获得了成功,有的付出了生命的代价,并分析了自我实验的价值和局限性。 Franz Reichelt: (间接通过旁白和报道呈现) Reichelt坚信他的降落伞服能够拯救飞行员的生命,为了证明其价值并获得商业赞助,他选择从埃菲尔铁塔进行高风险的自我实验,最终导致不幸。 Barry Marshall: (间接通过旁白和报道呈现) Marshall为了验证幽门螺杆菌导致胃溃疡的理论,冒着健康风险进行了自我实验,最终证明了他的理论,并因此获得了诺贝尔奖。他承认自己当时过于自信,并建议在进行自我实验前应进行更充分的研究。 John Hunter, Max von Pettenkofer, Werner Forsman: (间接通过旁白和报道呈现) 这三位医生的自我实验案例,展现了历史上医生进行自我实验的传统,有的取得了成功,有的付出了生命的代价,他们的经历为我们理解自我实验的风险和价值提供了参考。

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Franz Reichelt, a tailor fascinated by flight, invents a parachute suit to save aviators' lives. He plans to test it from the Eiffel Tower, despite previous failed attempts with a mannequin.

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Pushkin. The first floor of the Eiffel Tower. Almost 200 feet above the ground. Next to the railings, a table. On top of the table, a wooden chair. And standing on the wooden chair, a man. Franz Reichelt. He places a foot on the railing. He leans forward and peers over the edge. The year is 1912.

and Franz Reichelt is a tailor. 33 years old, born in Austria, he moved to Paris as a teenager and built a modestly successful business in ladies' fashion. But ladies' fashion is not what excites Franz Reichelt. He's fascinated by flight, and Reichelt has invented a parachute suit. Reichelt looks briefly up to the heavens. Early in the morning on the first Sunday in February, his breath forms in the air.

By 1912, parachutes are hardly a new idea. Leonardo da Vinci drew one centuries earlier. What is new is the fast-growing market for them. Airplanes have only just been invented. They're not yet very reliable. Reichelt is convinced that his wearable parachute can save aviators' lives. With his tailoring skills, he's made, well, I'll let a journalist describe it.

This all-silk garment, very well designed, was provided with a kind of very wide hood, which by means of zippers would automatically expand when called upon and form above the head a vast umbrella. Down on the ground, nearly 200 feet below, a few dozen people have got up early to watch the demonstration.

There are aviation enthusiasts, curious members of the public, and journalists from all the Paris newspapers. Reichelt has even drawn a film crew from the Pathé Journal cinema newsreel. One camera is on the ground, pointed upwards at him, waiting. Another camera is with Reichelt on the first floor, filming him. He's still standing there, one foot on the railing, one on the wooden chair.

But is he really going to jump himself? He's told the Paris authorities that he's going to put the parachute suit on a tailor's dummy and throw that off the Eiffel Tower. They would never have given him permission to jump off the Eiffel Tower himself. And yet, there he stands. Reichelt cautiously shifts his weight onto the foot on the railing. Then he shifts it back.

Is he having second thoughts? It is very windy. He sways gently, forward and backward. He looks over the edge again. 20 seconds go by. 30, 40. It's not too late to use the dummy. I'm Tim Harford, and you're listening to Cautionary Tales. MUSIC

In 1951, in a gold mining town in Western Australia, a 19-year-old apprentice engineer and an 18-year-old trainee nurse had a baby. They called him Barry. Barry Marshall would grow up to be tempted to test a pet theory on himself, much like the flying tailor Franz Reichelt was tempted all those years ago.

Growing up in Australia's back of beyond, young Barry Marshall liked to read his mum's medical textbooks and muck around with his dad's tools. He made firecrackers and guns and a device for pressurising domestic cooking gas to make balloons that were lighter than air. You want to be careful with those balloons, son, said Barry's dad. Might be dangerous if they meet an open flame. Let's see, shall we?

He drew on his cigarette and touched the lighted end against the balloon. Marshall recalls: "He was enveloped in a ball of flame and his eyebrows were singed off. This didn't worry us very much because we had seen him in this state before." In the gold mining town there was money to be made but not much choice of career path. Boys left school and they mined for gold. The Marshalls wanted their kids to have options.

So they moved their growing family 300 miles to Perth, the nearest city. Barry went to medical school and became a doctor. Every six months, he trained in a different speciality. When he moved to gastroenterology, Marshall quickly realised that stomach problems could be hard to treat. One woman on Marshall's ward was in terrible pain from gastritis. Inflammation of the stomach. Nothing helped.

In desperation, they sent her away with antidepressants. It wasn't uncommon to link gastric problems to mental health. Stomach ulcers were widely assumed to be caused by stress. Ulcer medicines worked sometimes, but often not for long. After a couple of years, many patients would be back with another ulcer. When medicines didn't work, patients would often have part of their stomach surgically removed.

But was the medical community missing something? One of Marshall's colleagues, Robin Warren, had a half-formed theory. People who came into hospital with a stomach complaint sometimes had a biopsy taken, and Warren had been looking at these biopsies. When the sample was from a patient with an inflamed stomach, he could see under the microscope that it was rife with a kind of spiral-shaped bacteria. It looked like tiny corkscrews.

Those bacteria weren't there with the healthy stomachs. Warren had observed this spiral bacteria many times, including on the biopsy of the woman Marshall had seen, the one who'd got antidepressants. Marshall was intrigued. He felt bad that they'd failed that patient. Perhaps there was something more they could have done. He volunteered to investigate Warren's idea. The medical textbooks weren't much help, but in a way that Marshall found paradoxically encouraging.

Every single pathologist in the whole world who wrote a book described Astritus totally differently. That meant to me that they didn't understand it. So I'm thinking, maybe these bacteria play a role in there. Marshall went to his hospital's library and played around with the computer. This was 1981, no internet yet.

But the library had just got a direct link to Australia's National Library of Medicine, and Marshall liked tinkering with technology. He spent months trawling through obscure literature and found suggestive references to bacteria and stomach complaints that went back nearly 100 years. It seemed that the evidence of a link was there, but nobody had yet connected the dots.

Marshall wrote up his findings and sent them to the organisers of a big gastroenterology conference in Australia. They weren't as excited as he was. They said, Dear Dr Marshall, we're so sorry that we couldn't accept your abstract. It was such a high standard this year. We had 67 applications and we could only accept 64.

Marshall tried to grow the bacteria, to study it better. Every time he got a specimen, he'd send it down to the hospital lab to see if they could culture it. And every time he visited the lab to ask how it was going, he got the same answer. Had the bacteria grown? No. Until one day, the day after the Easter holidays, Marshall received a phone call. Come down to the lab, the technician said. We think we've cultured your bacteria.

It turned out that Marshall's bacteria, Helicobacter pylori, or just H. pylori, require three or four days to start showing up. The lab was used to culturing bacteria that grow more quickly, such as E. coli. When nothing had appeared in the Petri dish after a couple of days, the technicians were throwing the samples out. They had succeeded this time only because Marshall had happened to send the last sample just before the four-day Easter break.

Now that Marshall knew how to grow H. pylori, his next step was to prove that the bacteria was causing the stomach illness. It could, after all, be a coincidence. Or maybe causality could run the other way. Perhaps the illness was enabling the bacteria to colonise the stomach. Marshall fed his bacteria to mice and rats to see if they developed stomach problems.

They didn't. He tried it on piglets. Every week, he'd feed them a portion of H. pylori and do an endoscopy, sticking a tube down their throat to look for stomach problems. Weeks went by, and nothing happened to the little pigs, except they grew into bigger pigs. After three months of this experiment, I had 70-pound pigs that I was wrestling with each week trying to do an endoscopy on, and it was a big mess, and the bacteria didn't take.

Marshall was exasperated. Mice and rats and pigs, after all, aren't people. And he was convinced that H. pylori was giving people ulcers. Some gastroenterologists were intrigued by the idea, but many others were dismissive.

To get their attention, Marshall decided he needed to show that if a healthy person got infected with H. pylori, they'd develop a stomach ulcer. But which healthy person could he ask to do that? There was one obvious answer. Himself. Like his dad, poking a gas-filled balloon with a lit cigarette, Barry was about to satisfy his curiosity in a rather reckless way. Though,

He didn't think it was too much of a risk. When I spoke to ulcer patients, they couldn't tell me about any illness they had had. They were perfectly fine. And then they developed an ulcer. So I didn't think I'd become unwell. Marshall had been feeding his pigs a small dose of bacteria every week. But would he really be able to persevere with consuming H. pylori himself on a weekly basis? He wasn't sure he could stomach it.

Better to summon up his courage once, he thought, and take one huge dose. Marshall and his lab technician brewed up a beaker of the potion. A couple of ounces of cloudy brown liquid. He hadn't told the lab technician what he was about to do with it. He hadn't told his bosses either, as he feared they'd try to stop him. He raised the beaker in his hand. Well, here it goes.

Down the hatch, the lab technician was horrified. We'll find out what happened after the break.

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Barry Marshall didn't expect to get a stomach ulcer right away. Many people, it seemed, can carry an H. pylori infection without developing any gastric complaints. If he's going to get an ulcer, he thinks, it might take years. He reassures his appalled lab technician that he feels perfectly fine and goes off to do his rounds on the ward, as usual.

It takes just a few days before Marshall realises that something isn't right. He's having one of his favourite meals, Chinese noodles. But the food is sitting on his stomach like a lump of lead. Boy, I feel so full! In the morning, he wakes up at the crack of dawn. I'm going to be sick. He runs into the bathroom and throws up. But it's not the Chinese food that comes back up again. Just a clear, slimy liquid. About a pint of it.

Well gee, that's weird. I don't do that very often. The next morning, he wakes up and vomits again. And the next. He visits his mother. He hasn't told her about swallowing the bacteria. Barry, are you constipated? How come you've got bad breath? Barry's work colleagues have also noticed his terrible breath. But they don't want to be impolite enough to tell him. Ten days after swallowing the H. pylori, he gets them to give him an endoscopy.

Usually I can tolerate the tube pretty easily with just a little gagging, but it was very uncomfortable. The endoscopy shows that the lining of Marshall's stomach is severely inflamed. This is great, says Marshall. Let's give it another few days and see how it develops. Marshall hasn't told his wife what he's done either. Barry?

There's something wrong with you. All night you're hot and cold. You're breaking out in a sweat. You're not eating your meals. You've got dark rings under your eyes. You look terrible. Well, you know, I took this bacteria and now I've got the infection. You did what? It's not like Marshall hadn't done any thinking ahead. He'd tested the bacteria he'd cultured to make sure that an antibiotic, metronidazole, would kill it.

It did, in the Petri dish at least. So he was fairly confident that he could cure himself by taking metronidazole if his illness got too worrying. Barry Marshall was the latest in a long tradition of doctors experimenting on themselves. Alas, that long tradition is not wholly reassuring.

John Hunter was an 18th century English surgeon, royal doctor to King George III. He was also the leading authority of his time on venereal disease. So much so that, according to some accounts, he gave himself gonorrhoea to study it better. He extracted pus from an infected patient and injected it into his own penis. This turned out to be a doubly bad idea.

First of all, none of Hunter's cures for gonorrhoea actually worked. Worse still, the patient also happened to have syphilis, and Hunter got that too, setting up a lifetime of worsening health. Or take the 19th century German chemist Max von Pettenkofer. Like Barry Marshall, he downed a potion teeming with bacteria. In this case, the bacteria that cause cholera.

He was trying to prove his theory that the bacteria didn't cause cholera. He was wrong. They do. And cholera can kill you. But von Pettenkofer was lucky. He just got a mild case of diarrhoea. In the 1920s, medical student Werner Forsman learned from his physiology textbook about an experiment someone had done on a horse. They inserted a tube in a vein in the horse's neck, pushed the tube into the horse's heart...

and inflated a rubber balloon to measure the changes in pressure as the horse's heart beat. The horse survived. Forsman wondered if a human would too. If you could insert a tube into a vein in a patient's arm, he thought, and push it into the heart, that might have some medical uses. Forsman went to the boss at his hospital and said, "Can I try this on myself?"

Absolutely not, said his boss. Imagine the scandal for the hospital if you kill yourself. Forceman decided to ignore him and do it anyway. He'd need a tube. To get the tube, he'd need to sweet-talk the nurse who held the keys to the supply cupboard. The nurse was 45-year-old Gerda Ditson.

The young doctor took her out to dinner and tried to persuade her of the importance of what he wanted to do. Nurse Ditson was completely won over. Do it to me, she said. They arranged a clandestine meeting in the lunch break. Nurse Ditson got out a 30-inch tube, a scalpel and a hollow needle.

She lay down on the surgical table and Dr. Forsman tied down her arms and legs to hold her still. Forsman then turned his back on her as if to arrange the instruments, but instead he performed the surgery on himself. He dabbed iodine on his left elbow, injected himself with a local anesthetic and used the needle to feed the tube into his vein. He went back to unstrap Nurse Ditson and tell her what he'd done.

She was furious. But she agreed to help Forsman do what he needed to do next: get proof that he'd pushed the tube all the way into his heart. Together, they went to the X-ray department and asked the technician to let them use the fluoroscope. On the screen, they could see where the tube was. Gently, Forsman pushed it further and further towards his heart.

The technician slipped out of the room to alert another doctor to what was going on. That other doctor now burst in. "What are you doing?" he yelled at Forsman. "You're crazy!" He tried to pull the catheter out of Forsman's arm, but Forsman fought him off, kicking his shins. "Nine! Nine! I must push it forward!" At last, the tip of the catheter entered his heart. "Take a picture," he told the technician.

Forsman had his proof. He wrote up his self-experiment and submitted it to a medical journal. It caused a huge fuss and Forsman was fired. He struggled to find a new job. Nobody wanted a heart surgeon who was known as a risk-taker and a rule-breaker. He retrained as a urologist, got a job in a small town where nobody had heard of him and joined the Nazi party.

Meanwhile, two American cardiologists read his old journal article and decided he was onto something. They turned cardiac catheterization into a practical technique to investigate heart disease and to treat it by widening blocked arteries. They received a Nobel Prize for their efforts and they shared that Nobel Prize with an obscure ex-Nazi small-town German neurologist.

nearly three decades after he'd tied up Nurse Ditson, Werner Forsman, had been vindicated. Just how big is this tradition of medical self-experimentation? A doctor and researcher called Alan Weiss set out to document every example he could find from the 19th and 20th centuries. He found 465. Then he looked at what had happened to them.

In seven cases, including Forsman, it won them a Nobel Prize. In eight, it killed them. The odds of death and glory were roughly equal. Barry Marshall's wife was not happy. She was worried about his health and worried that he might pass on the bacteria to her and their children. Start taking antibiotics, she tells him.

Give me till the end of the week, Marshall pleads. I want to have another endoscopy to see what's happening. By this point, Marshall has stopped vomiting up colourless slimy liquid. To his surprise, the next endoscopy shows that the inflammation is healing. He takes the antibiotics to be on the safe side, but he seems to have fought off the bacteria on his own.

Marshall has dinner with Robin Warren, the colleague who'd first suggested that he looked into the spiral-shaped bacteria on stomach biopsies. He tells Warren all about his self-experiment. The next morning, Warren is woken up at 5am by a call from an American journalist. They've scheduled a routine interview to discuss Warren's ulcer theory, but the journalist has got muddled about the time zone in Perth.

Because he's half asleep, Warren blurts out the exciting news. Barry Marshall just infected himself and damn near died. Marshall hasn't yet published his work in a medical journal, so the first report about it comes in an American tabloid newspaper. A sensational story about the Australian guinea pig doctor and his cure for ulcers.

That's not going to help my credibility, Marshall thinks. But unlike some of his self-experimenting predecessors, at least he was still alive.

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The tailor, Franz Reichelt, had kept his self-experimentation plans to himself. The workers he employed in his tailoring business thought he was planning to put his parachute suit on a tailor's dummy and throw the dummy off the Eiffel Tower. That's also what he'd told the Paris authorities he wanted to do when he asked for permission to use the Eiffel Tower for his test. The wait for that permission was agonising.

As Reichelt tried to improve his designs, bureaucrats waited a full year before giving him the nod. By then, Reichelt's workers were used to him throwing dummies off the fifth floor balcony of the building where he worked. The first prototype of his parachute suit had a canopy of just six square yards.

The dummy did not land softly enough. Reichelt redesigned the suit, this time with a 12-square-yard canopy. He threw the dummy off his balcony and the results were a little better. Reichelt made the canopies bigger and bigger, in the end over 30 square yards. And it seemed to him that the falls got gentler.

He found a quiet spot in a village to try the suit himself, jumping from 30 feet onto a bed of straw. But he also thought he saw the problem. He wasn't jumping from high enough. The parachute needed more time to slow the speed of his descent. On the evening before his date with the Eiffel Tower, Saturday, February 4th, 1912.

Reichelt wanted to make sure the media would turn up. He paid a visit to a journalist at a Paris newspaper. I've told the authorities I'm going to use a dummy, he says. Actually, I'm going to jump myself. You won't take any precautions? Not in the least. I want to prove the value of my invention. Word got round. And when morning came, the journalists were out in force. And the Pathé film crew.

One writer describes the inventor's "absolute calm and apparent good humour". Another says: "He's cheerful, brimming with confidence. He had put on a sort of brown jumpsuit, a little bulkier than ordinary clothing. The appearance was elegant, and the inventor rightly pointed out to everyone that his clothing did not hinder movement."

Some people made a last-ditch attempt to dissuade Reichelt from making the jump himself. It's not too late to use a mannequin, they point out. Will you at least think about postponing until the wind calms down? Reichelt is having none of it. You will see how my 72 kilos and my parachute will give to your arguments the most decisive of denials.

There are 347 steps up to the first floor of the Eiffel Tower. Reichelt starts to climb them, with one of the film crews in tow. He turns to look back at the crowd. "'A bientot,' he says. "'See you soon.'" Franz Reichelt wasn't included in the research that counted 465 cases of self-experimentation. That research looked at doctors, not tailors.

That research found the pace of self-experimentation was slowing towards the end of the 20th century, the golden age passed 100 years ago. Another researcher, Brian Hanley, doubts that. He thinks those figures are just the tip of the iceberg. Hanley has experimented on himself in gene therapy. He knows lots of other academics who've done the same but kept it quiet.

They worry that their institutions won't support them. They might be fired, like Werner Forsman all those years ago. Hanley decided to investigate why self-experimenting has such a bad reputation. He and his colleagues contacted the ethics departments of universities to see if they had a policy on it. There was no consistency, but they heard a common concern that self-experiments prove nothing.

It's called the N of 1 problem. If your research has only one subject, you can't learn anything useful.

You need bigger studies to draw wider conclusions. That's just not true, says Hanley. An N of 1 experiment can show that something is possible and more research is worthwhile. That's what happened with Werner Forsman and Barry Marshall. The sensational tabloid story might not have helped Marshall's credibility, but it got attention and led to bigger studies.

We now know that roughly half the world's population is infected with H. pylori, generally in childhood. For most people, it never becomes a problem. But for some, it causes stomach ulcers later in life. And we now know how to treat them. Barry Marshall joined the list of self-experimenters who won a Nobel Prize. The tailor Franz Reichelt, as you might have guessed, was not so lucky.

The Pathé newsreel footage of Franz Reichelt's jump from the Eiffel Tower is riveting and awful. The parachute never looks like unfurling. Reichelt drops like a stone. The autopsy will later reveal that as he falls, he's suffering a massive cardiac arrest. He fell with a dull thud onto the ground, his forehead bleeding, his eyes open, dilated with terror.

his limbs broken. The reckless inventor was dead. Reichelt had looked like a mad genius, quipped one journalist, but proved himself worthy of only half the epithet. It's easy to snicker, but is it fair? Wearable parachutes are not an intrinsically stupid idea. Reichelt's design failed, but today we have designs that work. Wingsuits that let you skydive like a flying squirrel.

And when a self-experiment goes well, it's easy to forget how much uncertainty it involved. Barry Marshall didn't expect to get symptoms so quickly. And he didn't expect the symptoms to self-resolve. "I was a bit overconfident in retrospect," he later admitted. "If we can't tell how big a risk is, how can we tell whether to take it?"

I think all we can do is examine our motives. Are we thirsting for useful knowledge that there's no other way to obtain, or trying to show off? Barry Marshall admits, with hindsight, that he was a brash young man, impatient to prove his older colleagues wrong. Asked if he'd do the same again, he says, I'd definitely study all the different angles of it further before I'd do it on myself.

Franz Reichelt looks like a classic case of hubris. There was, after all, a risk-free way to test his idea: use a tailor's dummy. To jump himself suggests he was delusionally overconfident in his own idea. That seems to be what most Parisian journalists assumed. But not all. One took the trouble to track down one of Reichelt's friends and ask what the inventor had been thinking.

The explanation is simple, said the friend. Intellectual property laws. Reichelt had managed to secure a patent for his parachute suit idea, but the legal fees had stretched his finances, and patents lasted for only 15 years. If he was going to make money from his invention, he had to commercialise it quickly.

That meant he needed a wealthy sponsor. And his only hope of getting a sponsor was a spectacular, attention-grabbing success. He'd waited a whole year for bureaucrats to give him permission to use the Eiffel Tower. He might never get another chance to make an impact. Death or glory? As he hesitated, with his foot on the railing for 40 long seconds...

Perhaps he'd already guessed the answer. Cautionary Tales is written by me, Tim Harford, with Andrew Wright.

It's produced by Ryan Dilley, with support from Courtney Guarino and Emily Vaughan. The sound design and original music is the work of Pascal Wise. It features the voice talents of Ben Crow, Melanie Gutteridge, Stella Harford and Rufus Wright. The show also wouldn't have been possible without the work of Mia LaBelle, Jacob Weisberg, Heather Fane, John Schnarz, Julia Barton, Carly Migliore, Eric Sandler, Royston Besserve, Magdalena,

Maggie Taylor, Nicole Morano, Daniela Lacan and Maya Koenig. Cautionary Tales is a production of Pushkin Industries. If you like the show, please remember to share, rate and review. Tell a friend, tell two friends. And if you want to hear the show ads-free and listen to four exclusive Cautionary Tales shorts, then sign up for Pushkin Plus on the show page in Apple Podcasts or at pushkin.fm slash plus.

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