The morbidity and mortality of scientific illiteracy.
Nowhere are the implications of these failings more apparent than in the health care system. Modern society expects a pill for every ill, a molecule for every, ailment - and it had better be a molecule with optimal efficacy and minimal toxicity. The obvious, but underappreciated, fact is that drugs and medical treatments are based on molecules. Not surprisingly, the development of medical therapeutics is dependent more on chemistry than on any other scientific discipline. Drugs exert their effects via a receptor, a macromolecule which is crucial to the pathogenesis of the disease under study. A first step in the rational drug design process is the resolution of the three dimensional structure of this receptor by a structural chemist, such as an x-ray crystallographer. Next, the medicinal chemists and organic chemists design and synthesize drug molecules to bind with the receptor. Computational chemists and molecular modellers facilitate this drug design process. Analytical chemists aid in determining the drug's pharmacokinetic half-life and metabolic properties. Finally, process chemists and chemical engineers work out methods for scale-up and quality control. This sequence of events is poorly appreciated in the general population for whom the realization that "physicians don't discover drugs, chemists do" is a startling revelation.
The failure to appreciate chemistry and the molecular sciences is apparent on an everyday basis in medical practice. In my own medical practice, the following five cases occurred during a recent two month period.
The first was a patient who refused to receive intravenous anti-migraine drugs because she was concerned that the sodium chloride and glucose in the intravenous solutions were synthetic in origin. She passionately believed that the molecules and even the constituent atoms themselves were fundamentally different between synthetic glucose and natural source glucose. For the safety of her own health, she "did not want to be exposed to synthetic atoms and molecules".
The second was a patient who abruptly stopped his anti-seizure medications. He did so after purchasing two rather large horseshoe magnets which he now places on either side of his head when he sleeps at night. He informed me that the magnetic field promotes the electrons of his brain molecules into higher energy levels, thus permitting "truly natural healing to take place". In fact, he was disturbed that I was unaware of such basic scientific principles as applied to issues of human health care. Because he had suddenly stopped his anticonvulsant drugs, he experienced several severe seizures producing a painful recurrent shoulder dislocation.
The third was a patient who stopped taking her cholinesterase enzyme inhibitor for Alzheimer's Disease. At her family's urging she was taking large doses of Vitamin E and Gingko biloba at four times the recommended daily dose, because "everyone knows that natural products are safer". The family refused to believe that their mother's recent haemorrhages were due to this mixture of agents - "vitamins and natural products are inherently safe and quite harmless".
The fourth is a patient who suddenly stopped his anticonvulsant drugs and began to consume massive doses of Vitamin B6 to cure his epilepsy. He had learned of this supposed cure from an internet chat-group. He soon developed severe numbness in his hands and feet from vitamin B6 toxicity, but refused to believe that a natural product could produce such side-effects. Moreover, since he had precipitously stopped his anticonvulsant drugs, he experienced multiple seizures, resulting in the loss of his driver's license and ultimately his job.
The fifth is an epileptic patient who decided to forego her conventional therapy in order to have "the bone plates in her skull manipulated". She had read that the skull is composed of bones which fuse as a young child. She had been told that incorrect fusion of these bones "impedes the harmonious flow of chemicals over the surface of her brain", thus causing seizures. She now visits an alternative medicine practitioner who literally beats up her head once a month to supposedly realign this claimed aberrant bone fusion. She stopped taking her anticonvulsants and has recently experienced a recurrence of her seizures. Not surprisingly, she now also has headaches.
These five people are not educationally deprived - all have high school education, two have post-secondary school education. They are simply average Canadians trying to do what they think is best for themselves.
The problem of scientific ignorance on the part of patients and their families is by no means restricted to patients with neurological problems. It is an issue which is becoming increasingly widespread. A recent high profile court case reported from Hull, QC further attests to this problem. A Quebec naturotherapist has been convicted of criminal negligence causing death after telling the family of a diabetic girl to substitute baths and herbal remedies for her insulin shots. The 12 year old girl died from complications of her diabetes on March 28, 1994. She died for want of insulin in Canada, the homeland of Banting and Best.
The situation is probably only going to get worse. Medical therapeutics are getting more complicated. With the new millennium will come improved receptor site specific drugs, gene therapies, anti-apoptotic agents, and a variety of other increasingly sophisticated chemical attacks on human disease. Members of the general public are increasingly less equipped to deal with such issues. This calls into question that sacred concept called "informed consent". As every physician knows (and as every lawyer is quick to remind us), it is the obligation of the physician to ensure that patients understand their therapies. Where does one start? Is it truly possible to obtain informed consent from all individual who genuinely believes that having their head systematically punched once a month to reshape skull morphology will beneficially influence neurotransmitter flow in the superficial layers of the cerebral cortex? Furthermore, with medical schools deleting chemistry as a prerequisite (to pursue "more human centred disciplines"), the physicians themselves won't understand the newly evolving molecular based therapies. It will ultimately be a situation with the blind leading the blind.
Concomitant with this rise in scientific illiteracy has been the blossoming of so-called alternative therapies. Yes, the snake oil salesman is back! Most alternative therapies are well intentioned, some may work, and a number are probably fraudulent. Alternative therapies come in a wide variety, including the good, the bad, and the downright ridiculous. First, there is the megavitamin approach. This is based upon the notion that if a little of something is good for you, then a whole lot is probably really good for you. Apart from producing expensive and usually brightly coloured urine, there are little if any hard data to support the widespread use of large doses of vitamins. Next, are the dietary approaches. There are the high protein/low carbohydrate, high carbohydrate/low protein, high protein, and no protein diets - all with the exact same therapeutic objective. These diets are sometimes coadministered with high colonic enemas and irrigations "to purge the body of its toxic chemicals". Once again, there is no scientific evidence to suggest that bowel toxins contribute significantly to the plethora of human suffering. Finally, there are the therapeutic touch practitioners. Therapeutic touch involves the practitioner systematically waving their hands over the affected individual. This supposedly promotes therapeutic perturbations in the conventionally undetectable human energy fields surrounding the patient.
Of all the alternative therapies, the most rapidly growing is the use of herbal remedies. In 1997, North Americans spent an estimated $12 billion for herbal and mineral products. Between 1993 and 1998, this market grew by 30-50 per cent. Within this same time frame, the US Food and Drug Administration received 2,621 reports of serious health effects - including 101 mortalities - linked to supplements. A small number of supplements dominate in the market. DHEA is a hormone reported to boost energy levels, augment muscle healing, and slow aging - it certainly received glowing recommendations from Mark McGuire. However, when it comes to toxicity DHEA doesn't hit the ball out of the park; it may increase the risk of breast and prostate cancer. Another agent with mixed effects is ephedra. Although ephedra (ma huang) has been purported to control weight while it re-invigorates, its use has been linked to high blood pressure, headaches, seizures, and even death. Like ephedra, yohimbe has also been put forth as an agent to re-invigorate and even to augment male sexuality: however, it possibly products weakness, paralysis, or death. Echinacea is widely used in the prevention and treatment of viral upper respiratory tract infections. Although several trials have suggested that the herb might reduce cold symptoms, long term use may paradoxically produce immune-system suppression. A 1997 US study suggested that Ginkgo biloba may symptomatically improve mental performance in patients with mild to moderate dementia. Nevertheless, its use is sometimes complicated by bleeding problems, gastrointestinal disturbances, and headache. Finally there is Saw palmetto. Preliminary work suggests that Saw palmetto shows promise for benign enlarged prostate disease; however, it too has its Achilles' heel, causing stomach upset, headache, and even erectile dysfunction.
The problem with alternative therapies like the herbals is not with their potential therapeutic benefits. Herbal remedies do contain an interesting mixture of flavone glycosides, terpene lactones, and various phenolic derivatives. Most chemists would agree that Mother Nature is a truly amazing synthetic chemist and that natural products such as herbals do represent an opportunity' for impressive molecular diversity. In fact, the recent growth of combinatorial chemistry is an attempt to reproduce this diversity generation in the laboratory setting. Rather, the problem with alternative therapies is the failure of society to hold them accountable to the same rigorous scientific scrutiny used for conventional drugs. Just because they are natural, doesn't make them safer. After all, cobra venom comes from an all natural source. The worsening of scientific illiteracy and scientific innumeracy combined with the flourishing growth of pseudoscience is not helping to ameliorate this situation.
In general, society places less value on the pursuit of scientific rigour, and is increasingly less inclined to listen to its mainstream scientists. When it comes to chemistry and the physical sciences, people think of thalidomide, DDT, and plutonium bombs. They do not think of penicillin, AZT, and Dacron aortic patches. A truly appalling event occurred earlier this year in Washington DC, when members of the Committee on Government Reform listened raptly to actress Jane Seymour extol the virtues of alternative medicine, such as homeopathic treatments for cancer and acne. Dr. Quinn, Medicine Woman was invited to present at the inquiry because "actresses are role models who have tremendous effects on public attitudes" and thus their opinions on science should be studied ("I'm not a doctor, but I play one on TV)". On the other hand, when the Nobel laureate Gertrude Elion recently died, her life did not make the cover of Time Magazine or the national newscasts. Elion had been involved in the discovery of drugs such as azathioprine, trimethoprim, and acyclovir (to name only three of the many drugs to which she was a central contributor). However, this hat-trick of discoveries is not enough to get her into the record books of the lay press. She did not strive for personal fortune or fame. She didn't set NHL, NBA, or box-office records. She just used good rigorous science to save many lives and to help humankind.
In the next millennium, humankind will have to confront an array of assaults. There is the spectre of prion diseases, killer viruses, drug resistant bacteria, and environmental cancers - prospects made even more scary by the decline of scientific literacy and the rise of pseudoscience. It is not productive to stick our heads in the sand while arrogantly decrying reductionism and the tenets of Western Science. These problems cannot be avoided; they will have to be confronted using good rigorous science as a weapon of salvation - a weapon hopefully wielded by people who know how!
Donald Weaver, FCIC is a professor in both the departments of chemistry and medicine at Queen's University in Kingston, ON. Weaver was the winner of the Merck Frosst Centre for Therapeutic Research Lecture Award in 1997 and is currently the director representing the Biological/Medicinal Division on the CSC Board of Directors.
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|Title Annotation:||medical therapeutics|
|Comment:||The morbidity and mortality of scientific illiteracy.(medical therapeutics)|
|Publication:||Canadian Chemical News|
|Date:||Jul 1, 1999|
|Next Article:||Lawrence Stanley Weiler, FCIC, 1942-1999.|