There’s an air of mystery to who gets a Nobel Prize and why. The answer lies in the Nobel Prize Archive in Solna, Sweden.
Nils Hansson, associate professor at the University of Cologne and currently visiting scholar at Harvard Medical School, takes us there. He’s gone through many nominations to find out what makes researchers in physiology or medicine worthy of the coveted prize.
ResearchGate: How did you come to study Nobel Prize winners in medicine and have you ever dreamed of winning one yourself?
Nils Hansson: No prize for physiology or medicine has been given to historical research, so mine would be the first. Joking aside, I’m not looking at the Nobel Prize to get hints on how to play the system in order to get the prize in the future. My aim is to study the mechanisms behind excellence in medicine, and I do that by using Nobel Prize nominations.
I’m a historian of medicine with a particular interest in the history of surgery over the last 150 years. Last year, I was a visiting scholar at McGill University in Montreal, working with professor Thomas Schlich, who has written extensively on the history of transplant surgery. When we discussed the history of transplant medicine we partly also spoke about the history of the Nobel Prize. Transplant medicine has always been a topic of interest for the Nobel Prize committee: At least eight prizes highlight research in that field. In 1909 the prize was awarded to Theodor Kocher from Switzerland who did transplant research and, three years later, to Alexis Carrel, also a surgeon, in recognition of his work on vascular suture and the transplantation of blood vessels and organs.
I think it’s a fascinating topic to study because transplant medicine was viewed as a visionary path to modern medicine. Today we may take it for granted, but a hundred years ago it was still very much cutting edge research – science fiction almost. It wasn’t possible to carry out successful organ transplantations, but the practical skills were starting to emerge at the turn of the 20th century. It should take another few decades before the physicians could deal with the organ rejection after the transplantation. So in Carrel's case, the practical significance showed decades after he was awarded the prize.
RG: So how does the Committee look for, find, and award excellence in medicine with the Nobel Prize?
Hansson: The Nobel Committee in Stockholm sends invitations to scholars all over the world to be nominators. They ask a few universities, researchers, and scientific societies to submit their proposals. The role of the nominator is quite interesting because he or she is like a salesperson: They have to describe how and why a certain scholar has done the most for the benefit of mankind, as Alfred Nobel stated in his will in 1895 – that’s at the root of the Nobel Prize. In my research I have, based on a few case studies, suggested that most nominators nominate friends or colleagues, mostly from their own university or at least from the same country.
RG: Is that because they know they can vouch for this person, or are there other reasons?
Hansson: I think that’s an important argument. Another historian, Elizabeth Crawford, argued that every country has favorite sons, who are being put forward by their fellow colleagues in the same country. In German surgery during the first half of the 20th century, for instance, they had a favorite son in Ferdinand Sauerbruch, who was nominated more than 60 times. In the UK more than 100 nominations came in for Charles Sherrington, a neurophysiologist who later also won the Nobel Prize for his work on the function of neurons.
RG: So the Committee hears from all of these people. But who makes the final decision?
Hansson: The Nobel Committee, which is usually made up of five professors from the Karolinska Institute, screens all the nominations. This year there were 327 nominations and about 57 nominations were proposing new candidates. The other ones were already proposed in previous years. A later step is to make a list of the most interesting candidates, who then go through a comprehensive evaluation by the Nobel Committee. Obviously, there are more prize-worthy candidates than medals to hand out so there are some negotiations in the Nobel Committee about which candidate should be proposed. The final decision is not made by the Committee, but by the Nobel Assembly at the Karolinska Institute in Stockholm. The assembly is made up of 50 professors of the Karolinska Institute.
RG: You spent a lot of time rummaging through the Nobel Prize archives for your research.
Hansson: The files for the physiology or medicine prize are kept in a building at the campus of the Karolinska Institute. I think one reason why it hasn’t received so much scholarly attention is that a large part of the files are in Swedish. The nominations are in English, German, Italian, and French, but all evaluations by the Nobel Committee are in Swedish – at least for the years 1901-1965. There’s a fifty year embargo on the files before they can be viewed by outsiders.
RG: What’s the most surprising thing you’ve found there?
Hansson: There’s one candidate, who I think is very fascinating. His name is Gustav Zander. He is nowadays quite unknown, even among historians of medicine. But in 1916 he was a strong Nobel Prize candidate for the invention of what we’d today call the gym. He constructed more than 70 apparatuses leading to a huge success. But the equipment was expensive and alternative forms of treatment arouse, until there was a revival of the gym in the 1970s and 1980s. So we can say that there was a rise, fall, and revival of his concept, which is, although modified, still relevant today.
Another prominent candidate who never received a prize in the end, was Harvey Cushing, who is said to be a founder of modern neurosurgery. Neurosurgery, in particular surgery of the brain, was recognized as one of the most spectacular transgressions of the traditional limits of surgical work. Cushing was nominated at least 38 times. In retrospect I think his nominators could have made a stronger case. They argued that Cushing, as the founder of neurosurgery, had done many things for neurosurgery and revolutionized the field. But they didn’t stress one single discovery – and that’s really the core of the entire Nobel Prize venture.
RG: Who got the most nominations for a Nobel Prize? Who got the most and never won?
Hansson: I can't say yet: I have mainly focused on the Nobel careers of surgeons. Ferdinand Sauerbruch got even more nominations than Cushing. He was certainly among the most nominated scholars but didn’t end up getting the prize. He had more than 60 nominations. But again, the number of nominations doesn't always say something about the importance of a scholar, but it may give some hints on his or her reputation in the scientific community.
RG: Why do you think he never ended up getting a prize?
Hansson: I don’t have to speculate because the reasons are in the reports. He did a lot of research on thoracic surgery. He constructed the Sauerbruch chamber, a pressure chamber for operating on the open thorax, basically a box with two openings and sown in gloves that kept the air inside at a different pressure than outside. It contributed to the worldwide scholar interest in thoracic surgery, but the Nobel Committee did not view him as the most outstanding pioneer in that field - and that’s often a main argument in the evaluations: the issue of scientific priority.
RG: Who got the fewest nominations and won?
Hansson: Most Nobel laureates are evaluated over decades, or at least for a few years. There’s one exception and, going to back to transplant surgery, that’s Alexis Carrel. He was French surgeon who worked in the US. He was only nominated once or twice in 1912 and got the prize the same year. That was really extraordinary. The media and medical journals in the US were thrilled and there was a moment of relief because he was the first Nobel Prize recipient for physiology or medicine who worked in the US. They claimed him as US winner. So I would say that even in the US and that early on, the Nobel Prize was the most prestigious benchmark of excellence in medicine. I think that’s so interesting, how the prize could get such a strong recognition so early, and as for today, the reputation still is outstanding among scientists and laymen.
RG: Why do you think that was and is the case?
Hansson: I’m trying to find that out in my research. It was an international prize with five categories: physics, chemistry, physiology and medicine, literature, and peace - and it was a great amount of money. I think Alexis Carrel got around $40,000 in 1912, which is more or less the equivalent of $1 million today. Alfred Nobel was also of course a very prominent person when he passed away. Of course, the media has also contributed a great deal. In order to get a fuller picture, we need to deconstruct the aura around the prize.
RG: Was there a Nobel Prize that we’d probably like to take back today? Why was it awarded at the time?
Hansson: That depends on how you phrase the question. Looking at it from a real-time perspective, it’s more complex to say whether there were any wrong decisions. But if you look at it from our present day perspective, commentators have questioned the 1949 prize for António Egas Moniz who introduced lobotomy to treat psychiatric disorders. But in fact, in 1949, even in major scientific journals like Nature, the decision was applauded. It depends on how we view history, from which point in time.
RG: There’s really no safeguard for that because the Committee only knows what’s known at the time, or is there?
Hansson: Well, they have one strategy to avoid it and that is giving the prize to people who made a discovery several decades or years ago. Then they can look back and see if a discovery really had some practical and theoretical significance. That’s one way of minimizing the risks.
RG: Is there something most Nobel Prize winners you studied had in common?
Hansson: Looking at how the nominators described the candidates, they were all said to have made some kind of breakthrough in science. The nominators often argued that the candidates were the first ones to do something, and they also said that the discovery had wide-ranging significance and was really original. These are a few key words you see quite often in the nominations: priority, originality, creativity.
RG: Is that also what the Committee says they’re looking for?
Hansson: The cornerstone still is Alfred Nobel’s, written in 1895. His testament is very short and he wrote that the prize was to be awarded the person who had conferred a discovery that has been of greatest benefit to mankind. Needless to say, there’s a lot of room for interpretation for the Nobel Committee when they try to single out anyone who allegedly has done that.
RG: Were there trends you could make out? Some fields that were more likely to get awarded?
Hansson: There were trends and major areas of interest that caught the Committee’s attention repeatedly. As I mentioned, transplant medicine played a big role throughout the 20th century, starting in 1909, and 1912 but also in 1990 when the prize went to Donnall Thomas and Joseph Murray, who transplanted in the 1950s.
In the first two decades of the 20th century a lot of bacteriologists, physiologists, and surgeons were nominated. Two major problems were addressed. The first one was malaria. Ronald Ross got his prize in 1902 for his work on malaria, “by which he has shown how it enters the organism and thereby has laid the foundation for successful research on this disease and methods of combating it.” Another prize went to Alphonse Laveran in 1907 for his discovery of the role of protozoa in diseases. Many more scholars who worked on some aspect of malaria were also nominated. The other disease nominators focused on in general back then, was tuberculosis. Carlo Forlanini, an Italian physician, who had an approach to dealing with tuberculosis was nominated 20 times. Robert Koch, the physician and pioneering microbiologist, was awarded the prize in 1905 for his investigations in relation to tuberculosis. Today, hundred years later, these two diseases have remained two of the deadliest communicable diseases.
RG: Do you have a favorite Nobel Prize winner?
Hansson: One that is particularly interesting is Werner Forßmann, the 1956 laureate. He held no university position at the time he was awarded the prize. It came as a surprise to many that the surgeon and urologist Forßmann got the prize for his early investigations when he was only 25 or 26 years old for cardiac catheterization. He did a self-experiment with a catheter, inserting it through a vein to the right ventricle. This experiment turned out to be important for further studies by, among others, André Cournand and Dickinson Richards, whom Forßmann shared the Nobel Prize with.
Another interesting aspect here is that the heart had long been seen as a no-go area in surgery. Just like some commentators thought transplant medicine was seen as medicine from a quack's textbook, famous surgeons like Theodor Billroth allegedly said in the 1880s that you would lose your reputation as a surgeon if you operated on the heart. But from the 1940s onwards, several surgeons were considered strong candidates by the Nobel committee for doing just that. The history of Nobel Prizes can thus also partly be seen as a history of breaking taboos in medicine.
RG: And the obvious closing question: Can you make a wild guess as to who’s going to win this year?
Hansson: I’m not allowed to view this year’s nominations, I have to wait 50 years, and I won’t speculate. What I can say, however, is that the winner will get global attention and fame, more than for any other prize, which is also what makes it so special.
This story has also appeared on Smithsonian.com
