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Breakthrough
Unknowingly, CUMC Doctor Saves James Bond’s Life

In the most recent James Bond movie “Casino Royale” the British spy is trying to save the world from terrorism when he sips a martini during a poker game and his heart starts beating erratically. Realizing he’s been poisoned, he stumbles to his car, opens his glove compartment, grabs an electronic device that runs a blood test and sends the results to London headquarters. London determines the poison is digitalis and tells Bond – now seconds from death – to inject himself with digitalis antidote. Is the antidote just another brilliant tool the British Secret Service has come up with to foil the bad guys?
   Actually, the antibodies used in the blood test and the antidote were first created by P&S professor emeritus of medicine, Vincent Butler, M.D., P&S’54, when he was a researcher in Presbyterian Hospital nearly 40 years ago. “Saving the life of James Bond is one of the more unusual uses of our antibodies,” says Dr. Butler, whose antibodies have saved the lives of many thousands of real-life people accidentally poisoned by digitalis.
   Until the 1990s, digitalis was the mainstay of heart failure treatment. But if given even in slight excess, the drug can cause potentially fatal arrhythmias (although usually not as fast as in “Casino Royale”). Unintentional overdosing was fairly common, because the effective dose varies from person to person. Complicating the situation, some doctors mistakenly took digitalis-induced arrhythmia for a sign of heart failure and gave even more of the drug.
   In the 1960s, Dr. Butler says about six patients died each year just at Columbia from digitalis poisoning. To avoid poisoning, doctors needed a way to measure the concentration of digitalis in serum. Dr. Butler, who was just starting his own immunology lab, decided to create antibodies to digitalis that could be used in an assay. ”The assay makes it easier to dose people and avoid levels that are too high, so the number of people poisoned has declined,” Dr. Butler says.
   Also in the late 1960s, Dr. Butler and his CUMC colleagues were the first to show in animals that the same antibodies could be used as an antidote to digitalis in lethal digitalis intoxication. Without the cardiology expertise or the resources to produce antibodies safe for use in people, he turned over his antibodies and methods to a group in Boston, which modified and tested them in trials. The antidote, marketed as Digibind, was approved by the FDA in 1986.
   “Whenever I gave talks on this work, someone in the audience would tell me about one of his or her patients who had been saved by the antidote,” Dr. Butler says. “Those were truly the most gratifying moments in my career.”
   Gratifying, yes. But Dr. Butler says getting the antidote where it was needed also led to some interesting adventures. “One Saturday afternoon in the 1970s, I was in my office when the phone rang. A doctor’s wife in Paris had poisoned herself with a massive dose of digitalis,” he says. At the time, the antidote wasn’t yet on the market, and only Dr. Butler and a few others had it.
   “I grabbed some antidote from the freezer, jumped in a car and sped to the airport, where an Air France cargo plane was about to take off. Unfortunately, there were mechanical problems.” Officials found another flight and raced Dr. Butler across the tarmac in a Jeep to the waiting plane. Dr. Butler handed the antidote to the waiting pilot and moments later the plane took off. The woman lived, just like Bond.

—Susan Conova

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