Nobel Prize in Physiology or Medicine

Nobel prize medal for medicine, Sweden, 1945, to Sir Alexander Fleming (1881–1955) who discovered Penicillin. On display at the National Museum of Scotland

The Nobel Prize medals, minted by Myntverket[22] in Sweden, are registered trademarks of the Nobel Foundation. Each medal features an image of Alfred Nobel in left profile on the obverse (front) side of the medal. The Nobel Prize medals for Physics, Chemistry, Physiology or Medicine, and Literature have identical obverses, showing the image of Alfred Nobel and the years of his birth and death (1833–1896). Before 1980, the medals were made of 23-karat gold; since then the medals are of 18-karat green gold, plated with 23-karat gold.[23]

The medal awarded by the Karolinska Institute displays an image of "the Genius of Medicine holding an open book in her lap, collecting the water pouring out from a rock in order to quench a sick girl's thirst." The medal is inscribed with words taken from Virgil's Aeneid and reads: Inventas vitam juvat excoluisse per artes, which translates to 'inventions enhance life which is beautified through art.'[24]

Nobel laureates receive a diploma directly from the King of Sweden. Each diploma is uniquely designed by the prize-awarding institutions for the laureate that receives it. In the case of the Nobel Prize in Physiology or Medicine, that is the Nobel Assembly at Karolinska Institute. Well-known artists and calligraphers from Sweden are commissioned to create it.[25] The diploma contains a picture and text which states the name of the laureate and a citation as to why they received the prize.[25]

At the awards ceremony, the laureate is given a document indicating the award sum. The amount of the cash award may differ from year to year, based on the funding available from the Nobel Foundation. For example, in 2009 the total cash awarded was 10 million SEK (US$1.4 million),[26] but in 2012, the amount was 8 million Swedish Krona, or US$1.1 million.[27] If there are two laureates in a particular category, the award grant is divided equally between the recipients, but if there are three, the awarding committee may opt to divide the grant equally, or award half to one recipient and a quarter to each of the two others.[28][29][30][31]

The awards are bestowed at a gala ceremony followed by a banquet.[32] The Nobel Banquet is an extravagant affair with the menu, planned months ahead of time, kept secret until the day of the event. The Nobel Foundation chooses the menu after tasting and testing selections submitted by selected chefs of international repute. Currently it is a three-course dinner, although it was originally six courses in 1901. Each Nobel Prize laureate may bring up to 16 guests. Sweden's royal family attends, and typically the Prime Minister and other members of the government attend as well as representatives of the Nobel family.[33]

Ralph M. Steinman was an inadvertent posthumous recipient of the Prize.

Because of the length of time that may pass before the significance of a discovery becomes apparent, some prizes are awarded many years after the initial discovery. Barbara McClintock made her discoveries in 1944, before the structure of the DNA molecule was known; she was not awarded the prize until 1983. Similarly, in 1916 Peyton Rous discovered the role of tumor viruses in chickens, but was not awarded the prize until 50 years later, in 1966.[55] Nobel laureate Carol Greider's research leading to the prize was conducted over 20 years before. She noted that the passage of time is an advantage in the medical sciences, as it may take many years for the significance of a discovery to become apparent.[56]

In 2011, Canadian immunologist Ralph M. Steinman was awarded the prize; however, unknown to the committee, he had died three days before the announcement. The committee decided that since the prize was awarded "in good faith," it would be allowed to stand.

Some of the awards have been controversial. The person who was deserving of the 1923 prize for the discovery of insulin as a central hormone for controlling diabetes (awarded only a year after its discovery)[57] has been heatedly debated. It was shared between Frederick Banting and John Macleod; this infuriated Banting who regarded Macleod's involvement as minimal. Macleod was the department head at the University of Toronto but otherwise was not directly involved in the findings. Banting thought his laboratory partner Charles Best, who had shared in the laboratory work of discovery, should have shared the prize with him as well. In fairness, he decided to give half of his prize money to Best. Macleod on his part felt the biochemist James Collip, who joined the laboratory team later, deserved to be included in the award and shared his prize money with him.[57] Some maintain that Nicolae Paulescu, a Romanian professor of physiology at the University of Medicine and Pharmacy in Bucharest, was the first to isolate insulin, in 1916, although his pancrein was an impure aqueous extract unfit for human treatment similar to the one used previously by Israel Kleiner.[58][59][60] When Banting published the paper that brought him the Nobel,[61] Paulescu already held a patent for his discovery (10 April 1922, patent no. 6254 (8322) "Pancreina şi procedeul fabricaţiei ei"/"Pancrein and the process of making it", from the Romanian Ministry of Industry and Trade).[62][63][64]

The Spanish neurophysiologist Fernando de Castro (1896–1967) was the first to describe arterial chemoreceptors and circumscribe them to the carotid body for the respiratory reflexes in 1926–1928. For many experts, this direct disciple of Santiago Ramón y Cajal deserved to share the Nobel Prize 1938 with the awarded Corneille Heymans, but at that time Spain was immersed in the Spanish Civil War and it seems that the Nobel Board even doubted if he was alive or not, being at the front since almost the beginning of the conflict. Heymans himself recognised the merits of De Castro for the Nobel Prize in different occasions, including a famous talk in Montevideo (Uruguay).[65]

Scandal and controversy resulted from the 2008 award to Harald zur Hausen for the discovery of HPV, and to Françoise Barré-Sinoussi and Luc Montagnier for discovering HIV.

In 1949, despite protests from the medical establishment, the Portuguese neurologist António Egas Moniz received the Physiology or Medicine Prize for his development of the prefrontal leucotomy, which he promoted by declaring the procedure's success just 10 days postoperative. Due largely to the publicity surrounding the award, it was prescribed without regard for modern medical ethics. Favorable results were reported by such publications as The New York Times. It is estimated that around 40,000 lobotomies were performed in the United States before the procedure's popularity faded.[66] Rosemary Kennedy, the sister of John F. Kennedy, was subjected to the procedure by their father; it incapacitated her to the extent that she needed to be institutionalised for the rest of her life.[67][68]

The 1952 prize, awarded solely to Selman Waksman for his discovery of streptomycin, omitted the recognition some felt due to his co-discoverer Albert Schatz.[69][70] There was litigation brought by Schatz against Waksman over the details and credit of the streptomycin discovery; Schatz was awarded a substantial settlement, and, together with Waksman, Schatz was to be officially recognised as a co-discoverer of streptomycin as concerned patent rights. He is not a Nobel Prize laureate.[69]

The 1962 Prize awarded to James D. Watson, Francis Crick, and Maurice Wilkins—for their work on DNA structure and properties—did not recognise contributing work from others, such as Alec Stokes and Herbert Wilson. In addition, Erwin Chargaff, Oswald Avery, and Rosalind Franklin (whose key DNA x-ray crystallography work was the most detailed yet least acknowledged among the three)[71] contributed directly to the ability of Watson and Crick to solve the structure of the DNA molecule. Avery died in 1955, Franklin died in 1958 and posthumous nominations for the Nobel Prize are not permitted. Files of Nobel Prize nominations show Franklin was not nominated when she was alive.[72] As a result of Watson's misrepresentations of Franklin and her role in the discovery of the double helix in his book The Double Helix, Franklin has come to be portrayed as a classic victim of sexism in science.[73][74] Chargaff, for his part, was not quiet about his exclusion from the prize, bitterly writing to other scientists about his disillusionment regarding the field of molecular biology.[75]

The 2008 award went to Harald zur Hausen in recognition of his discovery that human papillomavirus (HPV) can cause cervical cancer, and to Françoise Barré-Sinoussi and Luc Montagnier for discovering the human immunodeficiency virus (HIV).[76] Whether Robert Gallo or Luc Montagnier deserved more credit for the discovery of the virus that causes AIDS has been a matter of considerable controversy. As it was, Gallo was left out and not awarded a prize.[77][78] Additionally, there was scandal when it was learned that Harald zur Hausen was being investigated for having a financial interest in vaccines for the cervical cancer that HPV can cause. AstraZeneca, which with a stake in two lucrative HPV vaccines could benefit financially from the prize, had agreed to sponsor Nobel Media and Nobel Web. According to Times Online, two senior figures in the selection process that chose zur Hausen also had strong links with AstraZeneca.[79]

The provision that restricts the maximum number of nominees to three for any one prize, introduced in 1968, has caused considerable controversy.[17][80] From the 1950s onward, there has been an increasing trend to award the Nobel Prize in Physiology or Medicine to more than one person. There were 59 people who received the prize in the first 50 years of the last century, while 113 individuals received it between 1951 and 2000. This increase could be attributed to the rise of the international scientific community after World War II, resulting in more persons being responsible for the discovery, and nominated for, a particular prize. Also, current biomedical research is more often carried out by teams rather than by scientists working alone, making it unlikely that any one scientist, or even a few, is primarily responsible for a discovery;[19] this has meant that a prize nomination that would have to include more than three contributors is automatically excluded from consideration.[55] Also, deserving contributors may not be nominated at all because the restriction results in a cut off point of three nominees per prize, leading to controversial exclusions.[15]