番茄社区

Medical conferences come and go, but memories live on. Just ask anyone who attended the 1983 American Urological Association (AUA) meeting.

This year marks the 30th anniversary of the most memorable -- and outrageous -- scientific presentation in the history of medical conferences. Any medical conference. Ever.

In the interest of full disclosure, the scientific value of the presentation has been described as nothing short of revolutionary. Unfortunately, the history-making science has received far less publicity than the unique delivery of the presentation, which left a roomful of well-educated adults gobsmacked.

The scene was a hotel ballroom in Las Vegas. A crowd had gathered for the evening program of the Urodynamics Society, a specialty organization under the AUA umbrella.

The topic for the evening was "Physiology of Erection and Management of Impotence." The first hour of the program consisted of a presentation and discussion of "Physiology of Erection and Ejaculation." Nothing out of the ordinary, as this was a conference for specialists in genitourinary medicine.

The speakers for the program included a respected British neurophysiologist by the name of Giles Brindley, PhD.

In the audience that evening was Laurence Klotz, MD, of Sunnybrook Medical Center in Toronto, then a urology resident who was, he remembers, "like a sponge, soaking up all the information I could find, even if it wasn't in my area of interest, oncology."

A chance encounter on the way to the hotel ballroom introduced Klotz to the featured speaker.

"I got on the elevator, and next to me was a very slim man, who was very agitated," said Klotz. "He had a cigar box full of 35 mm slides that he was looking through."

At the time, PowerPoint was only a gleam in Bill Gates' eyes.

One other thing caught Klotz's attention: Brindley was wearing a warm-up suit.

Irwin Goldstein, MD, of San Diego Sexual Medicine, was another of the dozen physicians and scientists on the program. He also had a serendipitous meeting with Brindley before the program started. The two men checked their slides at the audiovisual desk at the same time and both went to the men's room. Brindley entered a stall and closed the door, only later did that illuminate a light in Goldstein's head.

Brindley was the first up. That was too bad for the rest of the speakers, as the audience probably remembered little of what they had to stay.

Brindley's presentation occurred at a key time in the evolution of therapy for erectile dysfunction (ED). The penile prosthesis, introduced a decade earlier, and psychotherapy were the only treatments in widespread use. Oral therapies, which everyone takes for granted today, were still 15 years away.

Effective medical therapy did not exist, in part, because of scientific disagreement about the physiology of the male erection.

"Some people thought muscles of the penis had to do one thing, which is contract, or you couldn't get an erection because you couldn't hold the blood in," said Goldstein. "The other group felt just as strongly that you had to relax the muscle to allow the blood to come into the penis."

Unbeknownst to everyone present that night, Brindley had decided to end the debate once and for all and leave no doubt that the "relaxation" camp was right. His presentation began uneventfully. The talk focused on achieving a penile erection by intracavernosal injection of a vasoactive substance, in this case, phenoxybenzamine.

As Brindley progressed through slides, so did a slight sense of discomfort in the audience. The slides showed a human penis in various stages of erection, beginning with abject flaccidity and progressing to the apex of phallic glory, courtesy of an injection of phenoxybenzamine.

Thinking back on their chance encounters with Brindley, Klotz and Goldstein came to a provocative yet somewhat uncomfortable realization: The penis featured in the slide show belonged to Brindley, a fact that Brindley confirmed to the audience shortly thereafter.

As if that announcement failed to get everyone's attention, Brindley subsequently told the audience that he had injected himself again just prior to entering the ballroom.

At that point, Klotz had a thought that probably crossed the mind of many others soon after: "Omigod, he's not going to do what I think he's going to do, is he?"

With little fanfare, Brindley stepped from behind the lectern and turned sideways to reveal a pronounced bulge in his pants. Brindley looked down at his handiwork and then at the audience. He turned in several directions in an effort to achieve the optimal angle for viewing.

Still dissatisfied with the display -- or with the audience reaction -- Brindley pulled his loose-fitting pants tightly against his groin and arched his back in an effort to give the audience an even better view of his successful experiment.

Klotz found himself hoping against hope. "Oh please don't do this. Don't do it."

At this point, the details become somewhat fuzzy and conflicting. Some accounts of the occasion have Brindley talking to himself and shaking his head in frustration over his inability to win over the audience. Others insist that some members of the audience disputed the "findings" and engaged Brindley in debate about the display.

However, no doubt exists about what happened next.

Goldstein recounted the denouement:

"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."

In a commentary published more than 20 years later in , Klotz captured the moment as he remembered it.

"There was not a sound in the room. Everyone had stopped breathing."

As if he still needed to convince any nonbelievers, Brindley stepped down from the podium and strode toward the audience, his clinical experiment bobbing up and down with every step, according to Klotz.

Brindley encouraged people in the audience -- which included the wives of some AUA members -- to come closer to get a good look. Some say Brindley even offered to let people touch his "experiment." Neither Klotz nor Goldstein could recall anyone taking Brindley up on the offer.

What happened next is unclear. Some people recall a period of chaos. Some remember the program chair somehow restoring order to the meeting. Many have no recollection of what transpired at that point, including the presentations of the remaining speakers.

To say the evening made an impression obviously understates the truth. Recently, Goldstein solicited recollections from people who were present that evening. Almost 50 individuals responded, including the wife of at least one AUA member. Goldstein incorporated many of their comments into an editorial in the .

"Within days [the presentation] had changed practice," Goldstein told 番茄社区. "The next day that I was home, we had people injecting their penis."

"This was an hour that changed many, many things. It changed a field, it changed therapy, it changed the way we think of things. It was an hour that changed the world."

Of course, any remembrance of the occasion would be incomplete without input from the person at the center of the incident. Now in his 80s, Brindley acknowledged by email "the nonmedical publicity which has caused some unpleasantness, but I have long ceased to worry about it."

Brindley insisted that "I had no intention of displaying it." However, the program chairman, Jacques Susset, MD, then at McGill University in Montreal, "dismissed my reasons and pressed me to do so. I don't think he foresaw at all how much trouble it would cause."

Susset, now retired, did not respond to a request for comment.

Then and now, Brindley viewed the incident as a step forward in scientific progress, not some kind of stunt.

"Science advances when a technique has been developed, and the results of using it either are useful or excite some scientist's curiosity," he said. "X discovers something, but if he had not, Y would have discovered it later, within 5 years if we are considering the 20th and 21st centuries and discoveries that are of practical value (emphasis retained)."

"For discoveries that are not useful, however interesting and beautiful they may be, the lag can be much longer. Some of the many discoveries in visual physiology that I made in 1952 to 1962 could have been made in 1852 to 1862 if somebody had had my kind of curiosity; the techniques already existed or needed only minor modification."

Brindley's curiosity took him to areas beyond erectile dysfunction, including gastrointestinal function and infertility, as well as the physiology of vision. He was an accomplished musician and designed at least one musical instrument. He also was an athlete, who competed in long-distance running into his 70s.

"There are only so many Giles Brindleys on the earth," said Goldstein, adding that he still considers it an honor to have been on the program with Brindley that night in 1983.

Comment