The dangers of the Nobel Prize Why was the inventor of lobotomies given science's highest honour?

This week, a small selection of scientists have been on tenterhooks, wondering if they’ll get a call from Sweden that’ll instantly change their lives. The most exciting time of year in the scientific community is upon us: it’s Nobel Prize season.

But this year’s winners would do well to consider what happened to many Nobellists after they accepted their prize. Take Kary Mullis, who won his Nobel as the inventor of the Polymerase Chain Reaction, or PCR (a fundamental technique that’s now used not just in Covid tests but in essentially all laboratory genetics research): he spent the last part of his life strenuously denying that the HIV virus causes AIDS. Or Luc Montagnier, who won his Nobel for discovering that very HIV virus — and went on to publish research on what amounts to homeopathy.

More recently, Michael Levitt won the Nobel in 2013 for important computer-modelling work relating to protein structure (his Twitter name “@MLevitt_NP2013”, NP for “Nobel Prize”, helps you see just what a big part of his identity the award is). Throughout the Covid pandemic, he has been drastically wrong in his rosy predictions — and sometimes conspiratorial-sounding theories — about the spread of the disease. In July 2020, for instance, he stated that Covid in the US will be “done in 4 weeks”.

All these brilliant scientists lost their grip on reality after they won their Nobel (and there are many other examples; there’s even a name for the phenomenon: Nobel Disease). But at least, in all those cases, the Nobel itself was awarded for a genuine scientific breakthrough. There’s one case where the prize was given, and has never been rescinded, for a disastrously misconceived “discovery” — one that went on to blight thousands of lives.

In 1949 the Nobel Prize in Physiology or Medicine was awarded to the inventor of a disturbing procedure — an attempt to treat mental illness — where a surgeon either injected pure ethanol directly into the brain to kill a clump of neurons, or used a special instrument with a sharp wire to slice away the connections between parts of the brain’s frontal lobe. Oh, and before they did so, they had to first punch or drill a hole through the skull — usually somewhere near the eye.

The frontal lobotomy (or sometimes “leucotomy”) wasn’t the first ever attempt at “psychosurgery” — the treatment of mental disorders by operating on the brain. But its invention is most strongly associated with the Portuguese doctor, politician and general polymath Egas Moniz. Inspired at least in part by previous research on chimpanzees, who became notably less aggressive and more docile after their frontal lobes were chopped out, in 1937 Moniz reported a case series of 20 patients suffering from conditions like anxiety, depression and schizophrenia whom he’d had lobotomised.

According to Moniz, his “very audacious” and “always safe” procedure — which he couldn’t perform personally due to crippling gout in his hands — worked wonders: the patients were more placid, more rational — and easier to control. He declared some of them “cured”.

But was this evidence any good? As the psychologist Ann Jane Tierney put it on the 50th Anniversary of Moniz’s Nobel Prize:

“A contemporary scientist can find considerable fault in Moniz’s work, including the inadequate follow-up times, absence of control groups, and the superficial and subjective evaluations of patients performed by individuals least likely to be objective.”

That is, even setting aside the upsetting nature of the procedure — and we should set aside our “yuck” reactions, since there are many horrific-sounding medical procedures that are genuinely helpful — the evidence that Moniz put together to support the use of lobotomies was hopelessly unscientific and biased in favour of his desired conclusion that the technique was useful.

And yet the Nobel committee, some years later, decided to give him the award. By this time, the lobotomy had skyrocketed in popularity and was being used across the world. The best-known proponent was the US neurologist Walter Freeman, an almost unreal character who seems straight from a medical-themed horror movie. Across several decades he performed thousands of lobotomies for an ever-widening list of complaints — not just psychiatric conditions, but also things like “being a badly-behaved child” — and did so theatrically, in front of an audience, often making the initial hole in the skull using an ice pick.

But, also by the time the Nobel was awarded, the horrific downsides of lobotomy were well-known: the fact that there was no evidence of any long-term benefits in the majority of patients was a quibble in comparison to the most obvious problem: the lobotomised were often changed entirely. Many emerged from the operation with altered personalities or slower-running brains; others lost physical abilities. Still others died immediately due to bleeds on the brain (Freeman claimed a 3.6% fatality rate but other sources suggest it was far higher). Most infamously, John F. Kennedy’s sister Rosemary, who had a learning disability, was lobotomised by Freeman and a colleague in 1941. The procedure, aimed at alleviating her seizures and aggression, was a disaster; it left her, permanently, with the mental capacity, independence, and continence of a small child. The story was hushed up, and Rosemary was kept in a psychiatric hospital and then a special school, far from prying eyes, until she died in 2005.

Even if he never intended for lobotomy to be used so terribly haphazardly, it does seem unlikely that Moniz deserved the world’s most prestigious scientific prize for inventing the technique. But there he is, on the official Nobel website among the other winners. We’re left with questions reminiscent of the ones being asked about statues of less-than-ideal historical figures: should we keep this reminder of a past that had very different values from our own? Should we somehow contextualise it? Or should we get rid of it altogether? Should we — more than 70 years after it was awarded — remove Moniz’s Nobel Prize?

It has been suggested before. There are still people alive today who were lobotomised early in life, often with tragic consequences, and it might be seen as a measure of justice for them and their families to remove the Nobel committee’s endorsement. It’s not unheard of in science: some journals have begun to remove or flag research papers, even very old ones, from scientists who are under serious suspicion of misconduct.

But Moniz’s research — while slapdash, especially by today’s standards — wasn’t deliberately fraudulent, at least as far as we know. If we were to go back and wipe out the historical science that now seems poor-quality to us, we’d have to disown huge swathes of the literature, and rescind any number of prizes awarded over the years. On top of that, context reveals that Moniz might technically have won the prize for lobotomies, but it’s at least plausible that the committee actually wanted to give it to him some years previously, for his work on cerebral angiography (a pre-computer technique, still used to this day, that allows doctors to X-ray the blood vessels in the brain).

Besides, it’s worth asking: what’s the point of rescinding a prize given to a long-dead scientist for a treatment that’s almost extinct? Everyone now knows how terrible a mistake the craze for lobotomies was; psychosurgery in general — almost entirely replaced by drug treatments during the latter half of the 20th Century — is nowadays vanishingly rare. Formally condemning it isn’t going to practically help any of its victims.

Perhaps the least the Nobel organisation could do is provide better context about Moniz’s award. At the moment, his page on their site notes, with some understatement, that the operation “could lead to serious personality changes”. The only other discussion I could find about him on their website is a bizarre essay from a psychiatrist in 1998 who defended Moniz in no uncertain terms:

“I see no reason for indignation at what was done in the 1940s as at that time there were no other alternatives!”

His phrasing isn’t exactly sensitive (the exclamation mark is in the original), but does he have a point? Lobotomy came before reliable psychiatric drugs or other treatments were developed; not all doctors who used it were as flamboyant or clumsy as Freeman. It’s among the worst dead ends in medical history, but shouldn’t we expect missteps and mistakes in our march towards scientific progress?

Maybe the real moral of the story — as well as those of all the Nobellists, who went off the rails — about the pitfalls of honouring scientists. The Nobel Prizes have been criticised as “absurd” in a world of collaborative, cumulative science that relies less and less on individuals. And maybe we shouldn’t expect there to be enough Earth-shattering discoveries for major awards to be given every single year.

That’s not to say we shouldn’t honour our best and most creative researchers; we just shouldn’t turn them into heroes with opinions that are somehow above criticism (a bit more criticism of our top scientists would’ve helped in the early stages of the pandemic, to give one obvious example). Perhaps having Moniz listed among the Nobellists is the greatest reminder possible that even the best scientists don’t comprise a pantheon of divine beings: they’re just humans, and some humans make terrible mistakes. Winning a Nobel doesn’t make someone infallible. It doesn’t even make their prize-winning discovery particularly “true”. The only thing that can do that — the only thing a scientist should really care about — is the evidence.

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