The Albert and Mary Lasker Foundation awards, often called the "American Nobels," will go this year to three scientists who helped deaf people to hear, two others who made fundamental discoveries about how the brain works, and two of the world's best-known philanthropists, Bill and Melinda Gates.
The prizes — $250,000 in each category — were announced Monday; the winners will be honored at a luncheon in Manhattan on Sept. 20. Since the foundation began making the awards, in 1942, 83 laureates have also won Nobel Prizes. These are the three categories and the winners:
CLINICAL MEDICAL RESEARCH Dr. Graeme M. Clark, 78, of the University of Melbourne in Australia; Dr. Ingeborg Hochmair, 60, of Med-El in Innsbruck, Austria; and Blake S. Wilson, 65, of Duke University in North Carolina.
The three scientists literally broke a sound barrier, developing the modern cochlear implant, a device that allows profoundly deaf individuals to hear and speak. They overcame enormous skepticism from other researchers and from advocates for the deaf, who said the earliest implants amounted to unethical human experimentation.
In 1978, the National Institutes of Health rejected an application for financing of human research on cochlear implants on "moral grounds." It later supported such efforts after limited early successes.
Dr. Hochmair and Dr. Clark, working independently, began their multichanneled cochlear implants in the late 1970s, an effort that Professor Wilson soon joined and went on to advance with a new strategy. The combined effort "for the first time, substantially restored a human sense with a medical intervention," the Lasker citation says.
Most hearing loss results from damage to the hair cells that help transmit sound waves through the snail-shaped cochlea in the inner ear to nerve cells the brain. The scientists' cochlear devices use electrical stimuli to bypass such cells; they directly stimulate the main auditory nerve that conveys messages to the brain for processing as hearing.
Cochlear devices have helped 320,000 recipients around the world; many are children who get the devices at age 1 or 2 and go on to attend regular schools. Most recipients can use cellphones and follow conversations in relatively quiet places.
Earlier devices offered limited benefit because many recipients could not understand spoken words without visual hints like lip reading. Dr. Hochmair and Dr. Clark improved on those devices, and in 1991 Professor Wilson reported a new speech-processing strategy that overcame the hurdle for most recipients. All the while, the scientists had to find techniques to minimize the risk of brain infections and other potentially fatal problems.
"In retrospect, we designers of implant systems had to get out of the way and allow the brain to do its work," Professor Wilson, an engineer who became a hearing scientist, said in an interview. "Once given a relatively clear and unfiltered input, the brain could do the rest."
BASIC MEDICAL RESEARCH Richard H. Scheller of Genentech in South San Francisco, Calif., and Thomas C. Südhof of Stanford University, for their study of neurotransmission, the process by which nerve cells communicate with other cells in the brain. When Dr. Scheller, 59, and Dr. Südhof, 57, set out independently 25 years ago to explore the field, much of it was virgin scientific territory. Researchers had not identified a single protein in the neurotransmission process.
The two scientists were cited for transforming what had been a rough outline into a number of molecular activities to provide insights into the elaborate mechanisms at the crux of neurological activities, from the simplest to the most sophisticated. They did so by systematically identifying, purifying and analyzing proteins that can rapidly release chemicals that underlie the brain's activities.
For example, the ability to taste, move limbs and use imagination depends on a biological relay system in which nerve cells spill chemicals to stimulate nearby neurons. The transmission process can take less than a thousandth of a second.
These two Lasker winners' discoveries are beginning to help provide a molecular framework for understanding normal functions like learning and memory as well as some of the most severe mental illnesses, including schizophrenia.
PUBLIC SERVICE Bill Gates, 57, and Melinda Gates, 49, were honored for "spurring initiatives and research that tackle some of the planet's toughest health problems." The couple have donated billions of dollars from their foundation and coordinated with a number of public and private agencies involved in health work, enhancing the quality of life of millions of people.
In an interview, Mr. Gates said he and his wife were "learning as we go" in raising the visibility of global health issues, collaborating with scientists to reduce the burden of diseases that largely affect the poor. That was an abiding concern of Mary Lasker (1900-94), who set up the foundation with her husband and lobbied for years to increase taxpayer investments in health research. Now, Ms. Gates said in the same interview, their successes are dividends from such research.
The Gates foundation's efforts include a heavy investment in buying vaccines for people in poor countries and in efforts to develop immunizations for diseases that have no vaccines yet. Another program seeks to educate African women waiting to give birth about simple nutritional measures to improve their family's health.
Still another is trying to develop low-cost toilets that do not require water, for use in Africa. Governments in poor countries do not have the money to conduct such research. Once the toilets are developed, wealthier countries can finance production on a larger scale. "Philanthropy can sometimes take the risk out of the equation" in undertaking the initial steps in the research, Ms. Gates said.
Despite the foundation's investments, "we're not even halfway through the kind of impact we can have in global health," Mr. Gates said, adding, "I wish we were."
At one time in his career, Mr. Gates was criticized as insufficiently generous in his philanthropy. But in an interview in 1998, when he announced a $100 million gift to speed the delivery of childhood vaccines to developing countries, he said:
"You can always look back and say, 'Hey, I could have sold all my Microsoft stock when I was 30 years old,' but that would have been worth a small fraction of what it is now, and that would have been all my philanthropy."
