Mentored by a Mad Man
Author: A.J. Lees
This refreshing blend of the unconventional and the orthodox is a testament to the bountiful spring of untapped ideas and inspiration that lies dormant off the beaten path of neuroscience. Part memoir and part academic excursion, the author of the book comes across as a quasi-dissident neurologist who dextrously rose through the formalist traditions of medicine to reach its clinical and academic pinnacles. Finding ‘the conformity of medicine’ suffocating, and the conservatism of the medical establishment antiquated, the author chronicles how he nimbly charted a uniquely maverick course whilst anchored within the rigid boundaries of mainstream neuroscience. The book documents the remarkable way the author attained scientific respectability through the landmark breakthroughs he made, all the while pursuing an exotic research agenda. It is equally striking that he maintains his unrelenting obsession for discovering chemical cures for Parkinson’s disease in the hallucinogenic plants of the Amazon rainforest. The book is however more than just a thrilling account of the author’s peculiar neuroscience journey, and the equally curious inspiration behind it; it is also a scathing critique of the medical research establishment. The author nevertheless acknowledges that the boldness he showed in highlighting the shortcomings of healthcare as a whole comes from losing his fear of the ‘censorship’ of his peers, and his dread of ‘being cast out by the brotherhood’ – a fate that ‘would have been a punishment far greater than imprisonment‘ (pages xvii, 5, 17, 52-55 and 65-66).
As reflected in its captivating title, the inspiration for much of the author’s academic career is William Burroughs, the writer who the author portrayed as his ‘dark angel, his ‘cultural guru‘, and his ‘guiding lamp‘. Even though he never met Burroughs, the author had read all his published letters and recordings, and possessed an encyclopaedic knowledge of his life and works. Through these, the author learnt of Burrough’s discovery and exploration of the psychotropic effects of the drug yagé – Banisteriopsis caapi. The author was particularly struck by Burroughs’ ‘wondrous flights of scientific fancy‘, and by his philosophy that ‘rationality could only ever rule part of our minds‘. These are indeed the concepts on which the author built his research approach which is to form hypotheses around ‘informed guesses, hunches, and imaginations‘, and on ‘unconscious wisdom, know-how and rules of thumb‘. The author also credited Burroughs for adding ‘a strange grace‘ to his research, a quality which enabled the author ‘to fly crookedly‘ in his ‘curiosity for cures’. And perhaps most importantly, it was Burroughs’ own exploration of the psychotropic effects of yagé that prompted the author to investigate its pharmacological effects, and this set him on a ‘new journey of radical empiricism‘ to the Amazon in search of ‘unimagined cures‘ (pages 5-6, 21, 102-111, 170-172, 145, 196, and 204-209).
The author’s academic career dominated the autobiographical narrative of the book, and this highlighted the rather radical methods by which he built his research portfolio – practices such as the self-experiments he carried out with apomorphine and deprenyl. The biography also conveyed his research foresight as shown by his early recognition of the addictive potential of levodopa, a drug he said is now known to cause such adverse effects as morbid jealousy, ruinous betting, reckless generosity, hypersexuality, and the repetitive ritualistic but purposeless activity called punding. It was indeed the rejection of his paper on this subject by the scientific journals that formed his poor opinion of what he called the ‘archaic and dishonest‘ anonymous peer review system which was ‘ponderous, prone to bias and abuse and a bit of a lottery‘ – a system he also rebuked for being ‘ineffective in spotting errors and deceit‘. Other autobiographical accounts in the book included the author’s rites of passage through the medical school traditions of cadaver dissection, which instilled in him ‘the carapace of insensitivity required to become a doctor’, and of autopsies, which taught him ‘the great level of uncertainty relating to the cause of death’ (pages 12, 15, 79, 83, 124-128 and 149-152).
A fundamental theme of the book relates to the insights the author acquired over the course of managing people with Parkinson’s disease. Many of these revelations were unfortunately disheartening, for example his realisation that the miraculous response of his patients to levodopa was transient, and that the benefit of levodopa was frequently accompanied by what he called ‘Cinderella moments of disablement‘ – unpredictable ‘flinging helicopter movements of the limbs’ and ‘distressing involuntary grimaces‘. These observations, the author recalled, made him realise that ‘making an individual whole again couldn’t be reduced to the prescription of a treatment however effective it was in improving quality of life‘. Conversely, some of his observations of Parkinson’s disease were heartwarming, and a typical example was his discovery of the ‘spectacular effects’ of apomorphine in freeing subjects from ‘the tyranny of Parkinson’s disease’, an awareness that proved to him that ‘the excavation and re-investigation of remedies consigned to oblivion was an alternative to the “bench-to-bedside” idyll of academic medicine’ (pages 25-27, 48-49, 124-128 and 194).
Perhaps the most educational themes of the book are those which documented the accumulated wisdom of the author’s long research career. In this regard, the dominant philosophy that emerges is the preeminence of open-mindedness in any scientific pursuit. The origin of this principle is perhaps the author’s observation that ‘almost all scientific research led nowhere‘, and that ‘on the rare occasions when it did, it often kicked off in a completely different direction from where it started’. This therefore explains why he relies on open-mindedness to choose research topics, and why he asserts that ‘good fortune and intuition‘ were ‘part of the game‘. This liberal attitude also serves as the source of his best ideas which he said flicker in ‘from the margins of consciousness‘, and take root ‘on the frontiers between bewilderment and understanding‘. This flexible stance also underlies the ‘serendipity and random combination‘ by which he searches for biochemical cures; the value he places on collaborating with ‘open-minded and sympathetic neurobiologists’ whose ‘rigour and ingenuity‘ guard ‘against credulity and the illusion of knowledge‘; and his reverence for the ‘freedom to disagree without censure, and a healthy disrespect for authority‘ (pages 204, 66 and 74-76).
A cornerstone of the book is the author’s critique of present-day research practice and regulation. For example, he condemned both the research policies which emphasise ‘process and political correctness, not ethics or good science‘, and ‘the sheer volume of inflexible rules, auditing and clinical guidelines‘ under which young researchers ‘were buckling under’. He also castigated the ‘extraordinarily bureaucratic, expensive and confusing‘ contemporary research protocols, and the ‘unnecessary bean counting and legalistic red tape‘ of research departments which have become ‘a cancerous growth eating away at novelty‘. The author extended his disapproval to the stringency of research guidelines which he argued have made clinical trials ‘three times longer‘ and ‘infinitely more expensive to conduct’, and which have left clinical neuroscientists ‘dreaming of the chimera of translational medicine‘. The author’s censure also extended to the research process itself which he said is now characterised by prejudices, conceit, jealousies, and vindictiveness, and to scientific papers which he said frequently brim with ‘technical language and obscure acronyms‘ which make them ‘incomprehensible to all but the cognoscenti’ (pages xvii, xviii, 71, 185-186 and 196).
The book is an exploration of how to do good research within the progressively restrictive prevailing regulatory atmosphere. The author had wisely kept his council as he ascended up the scientific and academic pole, managing to remain outwardly conformist but internally rebellious for so long. This is an indication of how deeply he holds his views, and the strength of the book largely comes from the unrestrained spirit with which he expressed his opinions. The book teaches not only the value of rigorous research in the pursuit of scientific goals, but the wisdom of listening to gut instincts, and finding insights in fleeting comments and radical ideas. It is also an appeal to reassess the whole scientific research edifice which the author argues stifles insight and progress.
This book conveys a unique perspective of research, one guided by instincts and open-mindedness, and it advocates a revision of current research policies which hinder the serendipitous and often oblique paths that lead to breakthroughs. The book outlines these and other ingredients of the author’s remarkable neuroscience advances – achievements which the author however downplayed in his continuing pursuit for better neurological treatments. In his life story is a lesson that the traditions of medicine should be flexible enough to accommodate unorthodox approaches, the foundations of many historical scientific revolutions. The author’s views and experiences are therefore invaluable for researchers who wish to stake their claim to uncharted medical territories. The book is also replete with wise suggestions for all medical scientists and research institutions, and I recommend it to all doctors.
Publisher, Place, Year: Notting Hill Editions, London, 2016
Number of chapters: 15
Number of pages: 213
Star rating: 5