The first boom in treatment for male erectile dysfunction came in the 1920s and 1930 when the Russian-origin French surgeon Serge Abramovitch Voronoff started to prescribe surgical implantation of monkey testicles in the human scrotum to augment sexual prowess. This gained quite a bit of fan following for a couple of decades and brough Voronoff a lot of fame, acclaim, and of course, money. Now Voronoff himself is a bit of a figure and could be the topic for a standalone post (maybe someday later). His process, however, was eventually lambasted by the scientific community in general and the public at large, when, after the initial success, the positive effects seemed to taper off. Many surgeons have held the opinion that Voronoff’s surgery did little to alleviate the condition and the greater part of his success could be attributed to the Placebo Effect! In the 1940s, his work came under fire from an eminent British surgeon, Dr. Kenneth Walker, who said the following about Voronoff:
“…no better than the methods of witches and magicians.”
Man was still hard at search for an answer once Voronoff was shot down, however, it all limped along. There were some moderately effective, yet overly invasive methods developed to combat this issue. One of them was the ridiculous-sounding method of implantable, inflatable phallic sacs. Yes. They literally blew up the male genital organ. The possibility of puns and innuendos multiplied manifold as a few more men achieved a hard-earned high. The Cleveland Clinic website claims that over 90% of the surgeries are successful and bring the patient much satisfaction, albeit it may be a shorter lasting one than the one reached in normal course. The images of such double cylinder implantations are also pretty ghastly. Here is a line drawing just to make your guts clench up inside:
Image courtesy: NIDDK (NIH)
So, after telling all of these gruesome procedures, if I were to tell you that they next came up with a drug that needed to be injected into the penis to overcome erectile dysfunction, I am sure you shall be less perturbed. This post is not about the remarkable history of the drug that was injected or any elegant studies conducted to examine its effect. No sir. This is simply a story on how to capture your audience, give them the scare of their lives and become a legend in medical conference giving for eternity.
This is the story of Dr. Giles Brindley and Papaverine.
The Urodynamics Society was meeting in Las Vegas in 1983 and one of the speakers, a Dr. Giles Brindley, had announced that he had found the cure for erectile dysfunction. Now prior to this, all efforts at finding an effective cure were more or less bust and hence his announcement was met with much enthusiasm and interest. Little did the scientific community know that they were in for more of a Vegas show than they had bargained for within the aegis of the conference halls. The details of this memorable presentation was published by Laurence Klotz (1) and provides a wonderful example of how (not) to present a conference talk.
The talk, innocuously titled something along the lines of “Vaso-active therapy for erectile dysfunction” was an evening talk and started off on a somewhat unconventional note. The speaker was attired in an inappropriately casual set of blue track suits: an odd choice for delivering the talk. The opening hypothesis was that injecting vaso-active agents into the corporal body of the penis might stimulate an erection. The problem with this hypothesis was, Dr. Brindley expounded, that there was no appropriate animal model that could be used. So, he did what every dedicated researcher does: self-experimentation. To the agony of the audience, he presented about 30 slides where he showed images of his genital organ in various stages of tumescence following the injection of various vaso-active agents like papaverine, phentolamine and others. While penile injections may seem like a regular treatment modality for us, back then, it was something unthinkable. Dr. Brindley had heralded the sexual revolution by thinking out of the box and daring to go big.
However, the surprised audience was in for a bigger shock.
Dr. Brindley, true researcher that he is, admitted that the presented data and slides could not justify whether any erotic stimulation had “confounded” the findings. Therefore, in a real life test, he had injected himself with another shot of papaverine just moments ahead of giving the talk. He admitted, that even he would not find the process of giving a talk in front of an audience sexually stimulating, and hence, any change in the status could safely be attributed to the effect of the drug. So saying, he decided to demonstrate the effect of the injections on his genitals and wrapped his loose-fitting clothes around his loins to silhouette the effect.
The audience, that was now scandalized, had not yet seen the explosion that was waiting to happen!
Dr. Brindley, being in the pursuit of the truth, was dissatisfied with the level of display and thought that draping his track suit tight was not helping very much, and so, he dropped his blue track pants (which he had worn because of the ease of abandoning them when the time came) and with his modesty held out in public, invited the members sitting in the front rows to examine the veracity of his claim to tumescence; much like a magician may ask for volunteers from the audience to check for any fraud of sleight of hand. Now there is some conflict as to what happened to trigger this massively unconventional event. Irwin Goldstein (who was in the audience that day, much like Klotz whose account has been one of the most widely read conference memoirs ever), felt that there was some dissatisfaction with the degree of evidence being displayed. This may or may not have been instigated by a part of the audience that disputed Brindley’s “over the clothes” show. Goldstein says:
“He became agitated and looked down and shuffled his feet as he tried to decide what to do next. After mumbling to himself a little bit, he said ‘Oh hell’ and pulled his pants down.”
One can only imagine the shocked silence that would have descended on the audience at such an audacious invitation! Just to send home the message, he waddled along with his pants around his ankles, over to where the audience was seated, transfixed, so that they could examine the degree of tumescence with ease. At this gesture, the women members of the audience shrieked and startled the self-absorbed academic who came round and pulled up his pants and concluded the talk. The audience dispersed, shocked to the core by his show-and-talk.
When there is a novel problem, it takes a mind with a novel thinking pattern to solve it. If Dr. Brindley tried to pull this feat off in today’s world, he would probably labeled a molester and sent off to the loony bin. However, back then, all he received at the time was shocked silence and looks of consternation from his irate colleagues. This eccentric British psychiatrist published the findings of this particular study 6 months later in the British Journal of Pharmacology. (2) He has published widely in the field of Neuropsychiatry and had over 100 original papers to his credit.
His eccentric exhibitionism was unconventional, just like his thinking, without which the breakthroughs in vaso-active management of erectile dysfunction would have been significantly delayed. This was because of the prevalent thinking that sexual response and stimulation were hormonally mediated. This was the basis of all the implantation and transplantation work that had been done till then. The other approach was mechanical – using implanted devices to deceive the organ into an erection. These were all stop gap measures, and none of them addressed the pathophysiologic basis of erectile dysfunction, until Dr. Brindley challenged the existing thought process and discovered a new mode of attacking the problem.
It was paradigm changing, epoch making research, that was presented in a jaw (and pants) dropping manner. This goes to show that even in hard core medical research and academy, drama goes a long way in consolidating a message. There have been millions of presentations on the same topic or on similar topics in thousands of conferences since the Brindley lecture, but his one act of eccentricity has pushed his talk into the lores of medical legend.
1. Klotz L (2005). How (not) to communicate new scientific information: a memoir of the famous Brindley lecture. BJU international, 96 (7), 956-7 PMID: 16225508
2. Brindley GS. Pilot experiments on the actions of drugs injected into the human corpus cavernosum penis. Br J Pharmacol 1986; 87: 495–500