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Needles to Say

On the altruistic innovation of the biopsy needle

By CORY FRANKLIN M.D.
   In the early 1950s, a polio epidemic ravaged North America and Europe. In a world largely forgotten today, people avoided drinking fountains, swimming pools and movie theaters. Summer camps and schools were closed, and even with these measures, thousands died or were crippled. Many spent months in iron lungs separated from friends and family. Then in 1955, physician-researcher Jonas Salk developed a successful polio vaccine and was hailed as a national hero. Thousands of lives were saved and thousands more were spared the debilitating effects of polio. Salk was on the cover of Time magazine—in the days when that was a true accomplishment, not a vacuous celebration of celebrity. Interviewed on the famous television program “See It Now” by Edward R. Murrow, Salk was asked, "Who owns the patent on this vaccine?" Dr. Salk replied, "Well, the people, I would say. There is no patent. Could you patent the sun?"
   It was certainly a different era, but that story has a special resonance in my family. At the same time Salk was becoming a household name, my father, also a doctor, developed a far less dramatic medical innovation, but one that nonetheless saved its small share of lives.
   At Cook County Hospital, my father had gained a reputation as an expert clinician and teacher. Doctors in those days spent many more hours in the hospital than they do now, and my father cultivated a hobby, refining ordinary medical instruments, making them easier for doctors and nurses to use. My father would tinker with the EKG machines and lab equipment, always looking for a way to improve them. One of his contemporaries observed that besides being a good doctor, he was “a clever gadgeteer.” In those days, there was no government regulatory scrutiny or review boards; if there were, he probably would have taken up contract bridge.
   Aware of his reputation, one day several nephrologists from the University of Chicago came to visit him. They were the local experts at a new technique—diagnosing and treating kidney diseases by doing kidney biopsies. This involved inserting a needle into the kidney, cutting a small sample of tissue and extracting it to be studied later under the microscope. Routine today, it was all very high-tech at the time. But the technique had run into a problem—two men, Vim and Silverman, had devised a crude biopsy needle before World War II that was still employed, and it often failed to capture a sufficient amount of tissue to study.
 Undaunted, my father saw no difficulty. Within a short time, he modified the bevel on the needle, and the new tool became known as the Franklin modification of the Vim-Silverman needle or simply, the Franklin needle. It was an immediate success. Sometime later, a leading nephrology journal wrote, “the modification of the needle by Dr. Murray Franklin of Cook County Hospital in Chicago was minor but crucial…for 15 years that was the standard renal biopsy needle used worldwide.”
   The elated nephrologists now did biopsies and published papers, eventually making Chicago the center of kidney biopsies and renal pathology in the world. Other medical centers quickly picked up on it. A nephrologist pioneering kidney biopsies at Vanderbilt University donated one of the first Franklin needles used at Vanderbilt to the Smithsonian Institute’s National Museum of History, Medical Sciences Division. My father, barely fazed by these developments, went back to caring for patients and teaching residents.
     But the story was just beginning. Cook County Hospital also had a number of world-class gastroenterologists who specialized in the liver diseases, and they had started doing liver biopsies to diagnose hepatitis and cirrhosis. They knew my father, who had done his postgraduate research in alcoholic liver disease, and they approached him to see if the Franklin needle would work as well for liver biopsies as it did for kidney biopsies. He told them, matter-of-factly, since the liver was a larger, more accessible organ than the kidney, it should work even better on that organ—which is exactly what happened. The Franklin needle also became the standard liver biopsy needle, first in Chicago, then all over the world.
   Thousands upon thousands of liver biopsies were done as the Franklin needle became a routine hospital instrument everywhere. It was instrumental to our modern understanding of liver pathology. In the 1960s, ambitious researchers from all over the country even started doing biopsies of the lung with it (although it wasn’t as good a tool for lung biopsies). The market for the needle expanded even more when veterinarians started using it to biopsy organs in animals.
   By this time, my father had moved on from academic medicine and never personally used the needle again. He rarely gave it a second thought. Growing up, I don’t recall ever hearing him mention it. I was vaguely aware of it since my mother occasionally told my sister and me about “the Franklin needle” used in the hospital. My parents’ friends, some of whom were physicians, would mention it to us when we were young as something of which to be proud. But it still made little impression on us.
   That changed one afternoon when I was in medical school. I was on the wards at Northwestern as a junior medical student. My job was basically to follow orders. A classmate and I were sent by the gastroenterologist we were shadowing to bring him a liver biopsy kit with a Franklin needle. At first unaware, it finally dawned on me what he had asked for. Normally, students are seen and not heard, but I piped up, “My father invented that needle.”
   He looked at me skeptically and eyed my nametag (thus confirming my impression that before that moment he hadn’t the faintest idea of what my name was—junior medical students, like Rodney Dangerfield, get no respect). After another skeptical moment, he beamed, “Your father is Murray Franklin? This needle revolutionized liver biopsies. You must be rich.”
  I felt an instant surge of pride that was quickly tempered by a sinking feeling. I certainly wasn’t rich, at least not that I was aware of, and suddenly I realized something might be amiss. For some reason I conjured up the image of all those old blues singers who made classic recordings, but made very little money, their profits siphoned off by managers and record companies.
   Returning to the gastroenterologist, I smiled and let the matter drop. He treated me with greater respect the rest of the month and gave me a better grade than deserved.
   As I progressed in my medical career, I came into contact with more and more specialists who used the needle. I never talked about it, but I realized even small payments to the creator of such a widely used innovation might be substantial. I refrained from asking my father about it for another decade.



Published: February 07, 2010
Issue: February 2010 Innovation Issue