His Immortal Remains

It is not a big reveal that scientists are no Rockstars. Few in the quotidian sphere run after a scientist for a selfie or are interested in their airport looks. In the 1650s, Sir Thomas Browne said it best when he wrote the following lines not about scientists but most applicable to them:

“Who knows whether the best of men be known, or whether there be not more remarkable persons forgot than any that stand remembered in the known account of time?”

Sure, there are the occasional Newtons, Einsteins, Darwins, Curies, and Hawkings, whose posters sneak into the rooms of teenagers or twenty-somethings who are sanguine about science. But largely, the persona of scientists is rarely proximal to the fame enjoyed by movie-stars, singers, politicians, businessmen, or reel or real celebrity criminals (such as the likes of Vito Corleone or Al Capone). Why this might be so, is the field of research of a social scientist. Since I am not one, I will leave it at that. What I will, however, like to weigh in on is that while money and fame elude the women and men of the sciences, when it comes to changing people’s lives, scientists come into their own. They do so in a non-partisan, all-pervading manner. Just like one-sided love is the most precious kind of love (as philosophized by Ranbir Kapoor and delivered even better by SRK), the most memorable contributions in the sphere of science are often faceless and nameless, where the person is overshadowed by the luminosity of the science. And although all scientific discoveries are precious, when such a faceless and nameless scientific contribution transforms human lives, no less than a billion at that, it is elevated to revolutionary proportions.           

Diabetes is a dreadful disease. It is the granddaddy of pandemics (a word that is everywhere these days), ongoing perhaps since the dawn of humanity and has arguably slain over a billion people in its 5000 years long career, since it was first documented. The link between elevated glucose and diabetes is antediluvian, identified as early as in the antiquity. However, in the absence of a tractable marker of the severity of the pathology, the management and treatment of diabetes remained impeded and onerous until the 1970s. Sure, blood glucose level is measurable and a near-faithful indication of the condition of the body whence it is drawn. However, since blood glucose levels are predisposed to short-term variations and a host of confounders, tracking the long-term progress of a patient solely based on this measure was noted to be an imperfect reflection of the underlying pathology. Therefore, the designing of treatment paradigms for the management of patients was desperately in need of a biomarker resistant to what you ate the previous day or how many steps you walked to get your blood tested.  

A contribution of epochal proportions was made with the discovery of the link between blood glucose levels and the levels of a modified form of hemoglobin called HbA1c, which is considered the “gold standard” for the management of diabetes. This, now taken for granted association, rests on the shoulders of the research conducted by Dr. Samuel Rahbar, who was born in Iran this month (12 May) in the year 1929.  Working across Iran, the UK, and the US during a lifetime that saw unprecedented progress in the field of protein chemistry and unprecedented political strife and turmoil in his homeland Iran, Dr. Rahbar was initially driven by the idea of uncovering new “variants” of hemoglobin. This was inspired in part with the then recent identification of the sickle cell hemoglobin, HbS. What he did chance upon in the blood samples of a lady was a strange new kind of hemoglobin, a little different from the most abundant form of hemoglobin, HbA. He also noted that the lady whose sample it was had diabetes. He was onto something and got the whiff of an epistemic and functional treasure trove. But since scientifically vetted observation is predicated on reproducibility, Dr. Rahbar was careful and skeptical of his own observation until he noticed the same kind of hemoglobin in blood samples from more people with diabetes.

Being the first person to witness a phenomenon is exhilarating and stupefying. But defining something bewildering as mysterious or divine may be the habit of the mystics. As one with a gritty scientific mind, mystifying was not the conclusion that would have satiated the curiosity. The unravelling of the nature behind this mysterious observation is what Dr. Rahbar wanted to steadily inch towards. Quick awareness of what else was happening in laboratories in other parts of the world in the late 1960s made it possible to pin down this new hemoglobin to HbA1c. HbA1c had been recently identified as hemoglobin that had glucose molecules attached to it. However, the link between elevated blood glucose and a simultaneous increase in the levels of HbA1c was not accepted with open arms by the scientific community. At that time, the prevalent view was that glucose could not be attached to hemoglobin “non-enzymatically” or simply put by brute-force. However, Dr. Rahbar’s conviction was rooted in a scrutiny of his own work and the naked strength of unbiased observation. Slowly, independent observations supported the findings and before long, HbA1c was acknowledged as the best indicator of long-term blood glucose. Since then, countless studies have established how tracking HbA1c levels can help predict and thereby allay the risks of kidney damage, eye damage, nerve damage, and, to an extent, heart failure and stroke in diabetes. International treatment guidelines revolve around the meeting of HbA1c “targets” and the success of diabetes management is measured against the ability of a treatment to control HbA1c. In other words, HbA1c has in the course of time, become the poster boy of the universe of diabetes medicine. None of this would have been possible if the prevalent view were perceived as the truth. Neither would it have been possible if Dr. Rahbar had been satisfied with the identification of a “mysterious” form of hemoglobin. This discovery needed the conflation of a challenging of the zeitgeist and a desire to explain. Still, the person of Dr. Samuel Rahbar remains obscure. Sure, there are critiques of the value of HbA1c in predicting treatment outcomes and rightly so. Emerging data suggest that the correlation between HbA1c and clinical outcomes is not fool proof. In future, better ways of predicting the clinical outcome of treatments are certain to evolve. Scientific progress, after all, feeds on skepticism, which should be distinguished from cynicism, and dynamic advances to present day knowledge and technology.

Present day corporate axioms frequently posit, and with good reason, the endorsing of one’s own brand and the advertising of one’s own achievements as the sine qua non of success. However, Dr. Samuel Rahbar’s scientific journey and unparalleled contributions are a reminder that doggedly treading on a path to excellence may not guarantee fame or wealth, but when your work transforms people lives and wards off a billion mortalities, your legacy, though nameless, gets etched on the totems of eternity.