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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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« Layoffs. More Layoffs. | Main | When Placebos Were All There Were »

December 17, 2008

Awkward Conversations

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Posted by Derek

We need a lighter topic today, and I’ve got one appropriate to the season, since many people will be having parties and family get-togethers over the next couple of weeks. And although some of these will be full of scientists, there are others where you might be the lone representative from the world of chemistry, biology, or medicine. That can be a good thing – or not so good, depending on how the conversation turns. A reader e-mailed me an account of a recent encounter with a relative who assured him of the benefits of foot-bath detoxification to cure what ails you. As you'd imagine, he didn't quite sign on to that idea, and the discussion went through a few rocky rapids.

I know that this sort of thing has happened to me several times. I’ve had to deal with the topics of how no, it’s not a conspiracy of the drug companies to make vitamin-based therapies illegal – and how yes, I have been working for X number of years in the drug industry without discovering a single thing that’s on the market, and how that’s statistically rather likely. And I’ve explained how it’s hard to come up with a cure for Alzheimer’s when you don’t even know what causes Alzheimer’s, which argument generally meets with agreement. But that reasonable discussion gets canceled out by plenty of others.

Dealing with the crazier propositions takes some real tact. I’m a pretty even-keeled guy, so I generally take a calm approach, just telling them how it is for me after X years of experience in the drug industry. I've found it's harder for people to spout craziness when there's some reasonable person sitting across the table from them who makes a living on the opposite side of their beliefs. And, truth be told, many of the wilder beliefs in the health field aren't necessarily all that strongly held. Most of them don't stand up to much scrutiny (and contradict each other, to boot), and I've found that people pick up and discard them with relative ease.

But you do run into passionate believers now and then. I'd be interested in hearing from people how they've dealt with conversations like this. My usual progression goes something like:

1. That's interesting - where did you hear about this?
2. No, it's true, I really have been working on those diseases for years now. As far as I can tell, they're pretty hard to deal with.
3. Gosh, that anecdotal evidence sure does sound convincing. Pity the FDA won't let us use any of that where I work. Those nutritional supplement manufacturers sure have it easy since the Hatch-Waxman act, don't they?
4. Hmm, since Fact X seems to be true about Disease Y, based on all that I know about the subject, how do these fit together?
5. Well, you know, the laws of physics/chemistry/math that I learned don't seem to cover that particular effect - have they added some recently?
5. No, I think that if there were any conspiracy that big, I probably would have noticed it at some point. Unless you're suggesting that I'm part of the cover-up?
6. Actually, people in the drug industry die from Disease Y, too. You'd think that if we were sitting on the cure for it, we'd have some sort of employee program or something. . .

Comments (30) + TrackBacks (0) | Category: General Scientific News


COMMENTS

1. RB Woodweird on December 17, 2008 9:31 AM writes...

If you have a PhD and a JREF username and you are hanging out during the holidays with your family who are wiccans and into astrology, acupuncture, herbal medicines, etc, you have two choices when the conversation turns to woo and you are contradicted by another:

1. Well excuse me! Where did you get YOUR doctorate?
or
2. Change the subject.

Believe me, choose 2.

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2. HelicalZz on December 17, 2008 9:37 AM writes...

Ah the holiday tradition of 'isn't the pharma industry just awful' conversations. I let them talk a bit, make a couple of points, suggest a few places for information if they'd care to educate themselves a bit more, then change the subject if possible. Hmmm... never considered sending them to your blog though - LOL.

I do financial writing too, so a segue to the stock market is pretty easy these days as well -- talk about getting passions inflamed.

Zz

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3. Jose on December 17, 2008 9:43 AM writes...

I had a conversation where the matriarch of the family I was celebrating with was explaining to me that a raw (as in uncooked) diet are so important beasuse cooking just denatures many of the proteins. "Yes, that is quite true. Benefitial even...." "well, we are all born with a set bank account of proteins and enyzmes, and if you don't replenish it, you get sick." I started to explain gastric juice, chyme and the digestive process.... but then wisely chose to change the topic....

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4. Retread on December 17, 2008 9:48 AM writes...

Do not go into medicine if you can't deal with this sort of thing, as you will meet it every day -- natural vitamins, foot reflexology, chiropractic, etc. etc. But --- don't be too smug, even the strongest among you are likely to turn to the irrational (or at least have irrational thoughts) when faced with disability or death. I've seen it happen many times.

When I first heard that a close family member had cerebral palsy, the first though that flashed through my head was that I, as a neurologist was somehow responsible. I was absolutely appalled that I would ever think such a thing (but there it was). Fortunately, his handicaps are all physical, and he later got a Rhodes.

I put up a post yesterday on the "Skeptical Chymist" which might be of interest to protein afficianados (or people making molecules which hopefully will bind to proteins and change their behavior).

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5. Doug on December 17, 2008 10:03 AM writes...

I had a biochemistry professor in grad school who was a real hoot. One day in the middle of a lecture on a particularly dry subject he looks up at us and says "now you may be wondering why you would ever need to know this stuff. Well, one of the burdens of posessing a PhD is that when your neighbors find out you've got one, they'll expect you to know everything. So you may as well pay attention and learn this. You don't want to dissapoint them."

While I don't get that kind of respect at family gatherings, I have a secret weapon. My dad is a scientist and much more outspoken than I. The kooks in my family know to tread lightly so they don't get him started about "all that science stuff" again.

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6. Kent G. Budge on December 17, 2008 10:56 AM writes...

The very most awkward party conversation I ever had was with a man who believed the earth was hollow and the Ten Lost Tribes of Israel were living inside it. The aurora was the light from the hollow interior coming out the holes at the poles and reflecting off the atmosphere.

Just about bit my tongue in half.

Later I was very grateful to have exercised restraint. The fellow fell on hard times, I helped out a bit through my church, and the man's gratitude knew no bounds. Even folks with, shall we say, a shaky foundation in the sciences, are our fellow human beings.

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7. G Experiment on December 17, 2008 11:17 AM writes...

Well, how does science explain the 'placebo effect' then?

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8. Russ on December 17, 2008 11:22 AM writes...

There is no absolute correlation between scientific education and skepticism about alternative medicine. Recall the case of Linus Pauling and Vitamin C; having an ill loved one makes a believer of many scientists. Those who were associated with the Cal chemistry department in the early 80's will recall a professor who was a passionate advocate for Laetrile.

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9. milkshake on December 17, 2008 11:33 AM writes...

I can see one reason to interfere with the wild beliefs - when someone is duped by a charlatan into thinking that an expensive herbal supplement and homeopatic drops will "correct" his diabetes or that fasting and a prayer will make his kids' cancer chemo unnecessary.

But even then it may be more effective to reason with the family members of that deluded person rather than challenging these beliefs head on.

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10. SteveSC on December 17, 2008 11:38 AM writes...

There is unintentional bias in science though. On the for-profit side things that aren't proprietary and can't be defended from competition receive minimal funding. This means that a patented molecule may have several 'gold standard' clinical trials, while a 'natural' product that is active at the same receptors has much more limited, or only 'anecdotal' evidence (e.g., melatonin v. ramelteon).

On the not-for-profit side things are no less biased, although more toward the scientific orthodoxy rather than profit potential. How many years did it take to accept H. pylori as a primary cause of PUD? Ten? Of course, the fact that pharma was making billions of dollars on drugs that relied on the scientific dogma didn't help.

You can roll your eyes at nutraceuticals, but some most likely work in some individuals. There are at least 350 vitamin-dependent enzymes and each has multiple versions depending on a person's genetic heritage. Some estimates are that 5% or more of these variations require higher levels of vitamin to reach full activity. If these less active versions are distributed randomly, then just about everyone has several enzymes which would work better with higher than recommended vitamin intake.

The problem is that we don't know who needs what, although eventually cheap genetic analysis may provide some guidance. Then all we need to do is figure out all the other co-factors in human metabolism! Unfortunately, this won't affect the bias towards proprietary and/or orthodox treatments.

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11. Bob Hawkins on December 17, 2008 12:06 PM writes...

I'm an atmospheric spectroscopist. I contribute the carbon dioxide absorption frequencies to the HITRAN database, which among other things is the foundation for global warming calculations. When global warming hit the news, at first I thought "Now when people ask me what I do, I can relate it to something they've heard of."

But then I did my due diligence and concluded that it's a crock. You think it's bad having pseudoscience spouted at you, try pseudoscience based on your own work. So I hit them back with some of the reasons for my conclusion, and they go away because they want to be the one lecturing. This doesn't make me popular but I just can't put up with it.

As Kipling said, "If you can hear the truth you've spoken twisted by knaves into a trap for fools..."

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12. Hap on December 17, 2008 12:43 PM writes...

My problem with nutraceuticals isn't that they don't work, but that the people selling them don't actually know that they work. If you claim that something improves X or enhances Y, you ought to have some data that shows it does so (and that what you're selling is the cause rather than a placebo effect), and in most cases, there doesn't appear to be that level of evidence (or, sometimes, any at all). In some cases, I suspect the people selling nutraceuticals don't even care whether they work or not (e.g. Enzyte?) - as long as the FDA doesn't ask any questions, they're OK.

There is a problem with the cost of trials making it unlikely that cheap, easily available compounds would be tested as treatments, but that would be a legitimate job for NIH. Insurance companies might also be interested (though I don't know how eager doctors and patients would be to trust their judgements).

"How do you know that it works?" seems like a good question to ask.

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13. Sili on December 17, 2008 1:35 PM writes...

I'm not diplomatic. But I don't have the proper knowledge to spout off as I do, unfortunately.

Got into an argument last Crimbo with an uncle about the evils of marijuana. I don't and have never smoked it, but that doesn't mean that I can't be in favour of legalisation. I support statesupplied heroin to incurable addicts too. Didn't help that he tried to turn it into an "it's all those bloody immigrants" issue too.

I've been mocking my work colleagues for their sympathy for acupuncture and reflexology lately (gently, I hope). Yesterday my 'boss' wanted to show me how he'd learned to dowse from his physiotherapist years ago. I think I had a little success, since this was not something very dear to him.

Easy too. He wanted to demonstrate how he could cancel the influence from the supposed underground water by plugging a device into the wallsocket (it looked like just a blank plug).

While he turned his back to walk the corridor again I turned off the power. And lo and behold he still couldn't register the 'water'.

I actually think that made him think.

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14. MikeyMedChem on December 17, 2008 3:22 PM writes...

Had an interesting conversation with a relative a few weeks back. They are fanatical about "chemical free" toys and things for their baby. Fanatical. Near as I can tell, the received word is from some paranoid parenting website. Then, when asked what they give their kid for teething, they described a homeopathic medicine. What's in it? I was surprised when I looked it up: subtherapeutic doses of "opioids" extracted from Deadly Nightshade (the toxic plant), calcium phosphate (to build strong teeth...even though the teeth are formed already and pushing through), and green coffee extract (to assist with wakefulness...er...to dose the kid with caffeine). This is a great example of "chemicals=bad; but natural=good". I pointed out that lead is natural.

Very frustrating.

BTW, there's an interesting and revelant commentary in the C&EN newscripts this week.

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15. Handles on December 17, 2008 4:34 PM writes...

One thing I have learnt from Ben Goldacre is the power of the placebo effect. All of these dodgy treatments do "work", just not via the pseudoscientific mechanism they postulate. I love that paper showing that "sham" acupuncture is just as effective as "genuine" acupuncture. Acupuncture works well for back pain because there is a strong psychosocial component of the condition, which is very susceptible to the placebo effect:
http://archinte.ama-assn.org/cgi/content/full/167/17/1892

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16. ANe on December 17, 2008 4:44 PM writes...

In a similar vein. As a pharmacologist I often get into tedious discussion on animal experiments. Now, I'm tired of this and found a reliable dinner conversation stopper: "Surely, no one could keep sane without sacrificing a rat by full moon?". It works. Either people think you are jesting, or that you are a bloody (literally) maniac. Topic is invariably closed - there is no real follow-up on this. I think this approach could be used for many other science-related issues where the audience is not amenable to rational arguments,,,

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17. MTK on December 17, 2008 4:56 PM writes...

One time at a bar someone asked what I did and when I said "chemist at a pharmaceutical company", she replied, "You're probably pretty smart. Why don't you use your brains for good rather than destroying our economy and environment?"

I had downed a few cold ones (OK, maybe more than a few), so I told her "Why don't you use your looks to scare Osama bin Laden out of his cave?"

The conversation didn't really continue after that.

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18. Hap on December 17, 2008 5:33 PM writes...

I have the feeling she either wasn't very smart or didn't really wanted to engage in an fruitful discussion. Normally when I'm talking to someone I might have an interest in (or someone I respect or don't want to hurt) and they do something I might disagree with (for example, work on the Bush reelection campaign), I might ask why they did that, what they found interesting, what they liked about their job, etc. I figure getting off a blast like "Oh, so you helped reelect that @$@#^&" would either imply a lack of impulse control, a rather involuted worldview, or enough disrespect to not be worthy of talking to anymore.

The problem with showing disrespect so early in a conversation is that the other person has no reason to hold back, and they might actually be much better at vituperation than you are - which apparently was the case here. Overall, she gets low scores for tact and overall performance, but you need to move up some weight classes to find better competition.

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19. milkshake on December 17, 2008 6:45 PM writes...

When confronted by an aggressive crackpot, the best way to shake him off is to flatter his imbecility by acknowledging that you don't really know the answer (because there is a wide range of possibilities) but there is a world-famous authority who actually specializes in the field... Then you pass along the home and office number to your most annoying colleague. It works well with your former boss that fired you, also.

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20. Todd on December 17, 2008 7:52 PM writes...

Thanks for the funny question. This reminds me of an interesting dinner I had on my vacation. There was this one couple from Ohio thee, and once they found out I was a research associate, I heard a lot about the wonders of naturals diets and how the big bad industry is forcing poison down the world's throats. Of course, she had no idea what she was talking about, but hey, I at least got out of it alive.

I think the key thing is that people fear what they don't understand. Most people understand more or less what goes on when you go to a doctor for treatment, but outside of our family members, few have a real clue what it takes to develop a drug. Unfortunately, we are deputized as ambassadors.

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21. SteveSC on December 17, 2008 10:42 PM writes...

Re comment #12:

The problem with leaving clinical studies of "cheap, easily available compounds" to the NIH is that the NIH is ruled by basic scientists, and is clearly biased against clinical studies (or at least tries to hold inherently messy clinical studies to the same standards as highly controlled bench studies--which amounts to the same thing). Also, NIH favors scientific orthodoxy.

Who decides which studies get funded? Why, people with a good record of NIH funding! Have an idea that is outside of the mainstream? The only way you will be funded is if you have a long track record of orthodox research and can overwhelm objections by the rest of the orthodoxy. (And yes, I have direct experience with NIH review committees from the inside.)

Of course, rabble rousers tend to reveal themselves early in their career, and can be safely shunted into 'commercial' research or out of science way before they are in a position to threaten the 'way things are'.

Re: the power of the placebo effect, just why is the placebo effect so denigrated? Here you have something that helps 40+% of the people treated, from a purely clinical aspect, why not? Of course I realize that from a scientific aspect it doesn't do you much good to elucidate mechanisms, etc., but the grimy little secret of clinical medicine is that it isn't very 'scientific' at all.

The majority of drugs don't work in the majority of patients. With the exception of antibiotics, which work pretty well once you identify which organism you are trying to kill, with most drugs you try this, then that, often a third, and perhaps a fourth, until you find something that seems to work. Doctors will say they use Drug A for Problem X, but what they really mean is that they have the habit of using Drug A first when presented with Problem X, but they will always have Drugs B, C, and D as backups for the common failure of Drug A.

So that 40% placebo response in gold standard clinical trials that is considered scientifically useless? When an individual patient walks out the door happy it is a clinical success.

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22. EH on December 18, 2008 12:57 AM writes...

Of course, a lot of claims about natural cures are based on the faulty presupposition that science does not in fact investigate natural compounds, such as vitamins, which is simply not true. Two particular examples come to mind, vitamin E and A. All evidence pointed towards Vit E being a solid preventative measure for heart disease, until the RCTs came out. Turns out, if anything, Vitamin E increases mortality from heart disease. And Vitamin A (or, to be precise, beta carotene)? Daily dosing increases the risk of lung cancer in smokers. But people are right about there being a magical panacaea for most of the diseases of our age. Walking for a mere thirty minutes a day can cure or prevent most of the diseases of modernity. Shame everyone would rather down st. john's wort instead.

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23. Handles on December 18, 2008 1:19 AM writes...

Re: why is the placebo effect so denigrated?
The following article (one of my all-time favourites) is great background reading in preparation for awkward conversations:

http://www.badscience.net/2007/11/a-kind-of-magic/#more-578

In short, prescribing placebos "medicalises problems, it can reinforce destructive beliefs about illness, and it can promote the idea that a pill is an appropriate response to a social problem, or a modest viral illness". There is also the ethical problem of lying to your patients in the age of informed consent.

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24. Morten G on December 18, 2008 5:38 AM writes...

"You're probably pretty smart. Why don't you use your brains for good rather than destroying our economy and environment?"

"Like what? Marketing?"

Comebacks could be a pretty good game.

Anyway:
The Hatch-Waxman act? Don't you mean the DSHEA? Good news. According to wikipedia the DSHEA will be amended in June 2010 to include demands of GMP for producers of supplements. "In addition, the industry is now required to report to the FDA "all serious dietary supplement related adverse events."" Which sucks of course. Doctors should be required to report them as well.
But I guess this is a step forward. Now you just need the restrictions on advertising that others have where you can't claim a medicinal effect of a product unless you have clinical evidence.

Permalink to Comment

25. MTK on December 18, 2008 8:18 AM writes...

To SteveSC,

This notion that mainstream science is not supporting the testing of supplements and vitamins is nonsense. Vit A and E, selenium, Vit C, folic acid, niacin, omega-3's, St. John's wort, saw palmetto...I could go on and on. There are lots of studies, some positive and some negative. The point is that NIH and other funding agencies do fund these type of studies. Often.

I will agree that in general there is a scientific orthodoxy which can be tough to overcome, but as a public funding agency such as NIH should spend our tax money wisely. To ask for some basic research into mechanism, animal model studies, or other hard evidence before plunging that tax money into expensive clinical trials seems prudent to me given whose money NIH is spending.

As for the placebo effect, first the 40% figure you cite is not normally the case, except for trials in areas such as depression. It's usually much much lower. Second, how would you propose taking advantage of this placebo effect on a wide basis? Have Pfizer, Teva, or GNC sell very expensive sugar pills backed up a multi-billion dollar marketing campaign? Remember the placebo effect only works if people believe it's going to work. So you are advocating that we allow companies to run a giant scam on the public?

Oh wait, that's exactly what you're advocating. Who cares if St. John's wort doesn't do anything for depression, people think it does so let them sell it as if it does. Well, if that's the standard that you want to hold supplements and vitamins to, then let's have pharmaceuticals be held to that same standard. Hey, it still "works".

Think about it, Steve.

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26. c on December 18, 2008 9:48 AM writes...

I like ask if they're prepared to sign some sort of waiver preventing their access to any of these nefarious treatments - should they ever get ill.

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27. SRC on December 18, 2008 1:36 PM writes...

I used to try to reason with crackpots (e.g., pointing out that botulinum toxin is all-natural too), but in my dotage I don't bother, having taken to heart the old adage about wrestling with pigs.

I just look reflective, nod gravely, and say, "Hmm. Interesting point. You may be right." (And then move on.)

It's pretty hard to argue with someone who's made such a vapid statement, and even allowed you may be right.

Life is short.

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28. SW on December 19, 2008 9:35 AM writes...

If the conversation goes to monies made (Less commonly these days), I make the rhetorical question " well, what industry would we want to do well? Making oil? Guns? I would prefer one that has proven it makes lives longer and better "

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29. Norepi on December 21, 2008 11:30 AM writes...

Aw jeez. This entry is making me laugh. I ended up sitting next to an old woman on an airplane earlier this week who was a homeopathic remedy nut. She was bandying on and on about her biofeedback business, the supplements and herbs that supposedly "cured" her cancer, and how the magnetic crystal she wore "balanced her energy." When asked what I did (medicinal chemist, academe, anticancer compounds), she almost put a dent in the ceiling over how doctors who prescribed "chemo" didn't know what they were doing.

Yeah. It was a long flight.


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30. SRC on December 22, 2008 12:57 PM writes...

Norepi, shoulda used my formulaic response, and then turned to reading intently, dozing, or something.

I don't collect royalties on the response. I give it freely to the right half of the bell curve to use ad libitum on the left half.

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