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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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« A 200-Proof Shot of Medicinal Chemistry | Main | More Crankitude: All Natural This Time »

March 22, 2011

Crankitude: A Quick Glossary

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Posted by Derek

I get probably more than my share of come-ons for various wonder-healing potions. For some reason, people see that I talk about drug discovery and think that I'm sure to be interested in homeopathic wonder water, magnetic healotronic belt buckles, or what have you. I am not. Well, at least not in the usual way that they're presented, as Great New Discoveries that I can order right now, first month's supply is free, and so on.

I also get to hear about many of these things at second hand, from people who write to me about them wondering if there's anything to them. And while I delete the press releases and advertisements, I respond to genuinely curious individuals, and I try to do so civilly. I tell them that no, according to what I know about chemistry, medicine, biology, and such, this things that they're describing won't (or shouldn't) work. I ask what kind of data might be available to back things up, and point out that in my own line of work we have to generate huge amounts of it before we believe we're on to something, and so on. I also try to get across how hard drug discovery really is, and how unlikely it is that there's going to be a Big Honking Breakthrough! every year or so, no matter what the ads on the radio say.

There are repeated themes in these things, and I'm by no means the first to notice them. Anything that promises to "boost your immune system", for example, is automatically suspect. Given what the immune system's capable of when cranked up a bit, I'd rather keep mine at its current setting, thanks. Of course, "detoxifying" is an instant red flag. As crank-watchers know, the conviction that we'd all be in perfect health if it weren't for insidious toxins is a widely held one, and a widely played-upon one. A corollary belief is that these toxins are piled up somewhere in your body, waiting for the right hand on the flush valve to clear them out and restore you to health.

Anything involving the word "energy" when applied to general medical concerns is worth a suspicious look. It's not an invariable sign of hand-waving, but it's common enough. This sort of language runs from the vague "gives you more energy" promises at one end to the mystical-life-forces stuff at the other. And related to that last part, appeals to Ancient Wisdom That We Have Forsaken are almost instant grounds for disqualification. Displacing the burden of proof in time (centuries ago!) or in space (the Mystic East) does not inspire confidence.

Naturally, as in any field, intimations of conspiracy are instant red flags. My friends, the Powers That Be don't want you to learn these wonderful things (but for $39.95, as it happens, you can hear about them until you're dizzy). Appeals to things that most people know of but don't understand well are worth scrutiny (most anything involving magnets, e.g.), as are attempts to make everything seem incredibly simple (Vinegar! The wonder-working key to health!)

In fact, what seems to be missing from most crank medical come-ons is, oddly enough, humility. There are no package inserts detailing side effects or symptoms to watch out for. There are no thoughts that any new data might sweep the latest discovery aside, and rarely any nods to others who have come before. No, this latest therapy is presented like a religious revelation - here it is, what you've been waiting for, and you'll never need anything else. Those of us who are trying to be on the other side should remember this, and try as much as we can not to sound like the people we can't stand. . .

Comments (39) + TrackBacks (0) | Category: Snake Oil


COMMENTS

1. Hap on March 22, 2011 2:39 PM writes...

If you just look certain enough and convinced enough when you say (write, etc.) something, apparently lots of people will believe you, even if you have no idea what you're talking about. Complexity and uncertainty freak (lots of) people out. Thus, humility in the form of admissions that the world is complicated, results are subject to change with new data, and we don't know everything (or even close) would break the spell and halt the reflex to reach for one's wallet or purse that is the main tool of dishonest people.

Of course, that would imply that honesty would discomfort people and send them running. Honesty is good for one's self, but I am not sure it's good for business. I don't know what to do about that.

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2. Jeb Bush on March 22, 2011 2:46 PM writes...

Yay! another post to incite all the Kevin Trudeau lovers again.

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3. Cynical on March 22, 2011 2:50 PM writes...

@1 : for a minute there, I thought you were describing politicians.

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4. Curious Wavefunction on March 22, 2011 3:21 PM writes...

- Complexity and uncertainty freak (lots of) people out.

They also just depress people and especially their egos. People want simple-sounding, ready-to-eat, dumbed down answers which give them a feeling of accomplishment at having understood something. And no, this is not the voice of the scientific elite belittling the great unwashed. Think about how much effort even we as scientists have to put in to understand something, and how much dissatisfaction we feel in the absence of understanding. We have to fight it out constantly. That's one reason why I think the snake-oil is never going to disappear. Human beings are blessed with curiosity, but they are also cursed with a tendency to hunger after quick, simplistic, ego-satisfying explanations.

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5. RogerBW on March 22, 2011 3:42 PM writes...

Ben Goldacre at http://www.badscience.net/ has written a lot of good material on this - his primary interest is analysis of medical evidence, but cranks and quacks are good examples of treatments that clearly don't work but are accepted by some people anyway.

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6. DCRogers on March 22, 2011 4:27 PM writes...

Another version comes in the Google ads with the grab lines: "San Diego mom discovers secret that doctors hate you to know!". (Secret might involve white teeth, acne, tummy fat, you name it.)

It's at best laughable to think of doctors stewing about some San Diego mom and her secret; but more seriously, it shows the deep mistrust of the entire medical establishment, and a shared belief that they're after one's money, not one's best health.

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7. Nick K on March 22, 2011 4:28 PM writes...

Excellent analysis of crank and woo, but you missed out the sheer venom and hatred of "Western Medicine" and "Western Science" (ie stuff that actually works) evinced by such people. It never occurs to cranks that doctors and surgeons in the Mystic East use the same drugs and treatments as their peers in the West.

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8. Pharmaheretic on March 22, 2011 5:17 PM writes...

But have you ever wondered why people are so mistrusting of medical 'authority'?

Could it be because many people rightly see them as corrupt charlatans who will peddle any drug or idea for the right price or twisted motivations- irrespective of efficacy or toxicity. What is the difference between a charlatan who has an MD and one who does not?

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9. RKN on March 22, 2011 5:26 PM writes...

"The Road To Wellville" springs to mind. Still one of my favorite books by T.C. Boyle. With a basis in historical fact.

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10. qetzal on March 22, 2011 5:29 PM writes...

@Pharmaheretic

The difference is that the MD peddles drugs that have undergone years of exhaustive testing, which provides some confidence that they work, and that we know what side effects they may cause. True, there's room for people to game the system, or outright lie to make and unsafe or ineffective drug look good. But it's not easy.

In contrast, the folks selling homeopathic wonder water that you apply directly to your forehead with your magnetic healotronic applicator get to say almost anything they want, and don't have to do any testing at all.

To boil it down for you, only some medical authorities are charlatans. Whereas the other camp is pretty much all charlatans, all the time.

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11. RKN on March 22, 2011 5:39 PM writes...

Human beings are blessed with curiosity, but they are also cursed with a tendency to hunger after quick, simplistic, ego-satisfying explanations.

If not also inexpensive, and OTC.

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12. nacbrie on March 22, 2011 5:53 PM writes...

Well, you know, herbal tea *can* treat malaria, and your headache, and sort out a dodgy heart, and cure cancer. That's not to say that taking the equivalent (toxicologically tested, dose-specified) pill won't do the same or better, and with less risks to health.

I reckon herbal medicine has some benefits (for one, encouraging a greater understanding of the local environment, botany, gardening, etc), but is highly dubious when you consider that (a) it's mostly claptrap; (b) what isn't claptrap and actually efficacious is still pretty weak compared to OTC medicines; and (c) sure what's a bit of accidental poisoning between friends? Even if you're not the idiot who goes around munching foxglove as an appetite suppressant, I'll take dextrose over thousands of possibly bioactive molecules, thanks.

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13. metaphysician on March 22, 2011 6:01 PM writes...

#12-

I want to stomp on and kill the meme "If its natural it must be good for you." I would say maybe 75% of all medical charlatanry ultimately is based on that idea.

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14. HK on March 22, 2011 6:10 PM writes...

Scenario - my brother is driving me and two of his friends to a party, with those two friends sitting in the backseat. One of them asks me what I do. PhD in synthetic chemistry, I answer. Oh that's so cool, she exclaims, what do you want to do afterwards? Probably work in the pharma, I reply casually. The girl sitting behind me has the audacity to hit me on the back of the head, having never met me before, saying "Why!? Don't you know what they DO!?" "Probably saved someone in your family a whole lot of grief, at one point or another."

Joe Schwarz came and gave a talk here for our inaugural IYC2011 event. Was pretty cool. The guy makes a living off debunking stuff like this. What do you guys think of him?

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15. luysii on March 22, 2011 6:11 PM writes...

My guess is that all the respondents are (1) well educated (2) young (3) have never been seriously ill, with something for which medicine doesn't have a good treatment.

If so, you simply have no idea how desperate and eager for hope people in situation #3 are. Having practiced in several areas long enough to get to know some people who I would later come to treat in #3, do not think that even you wouldn't listen to this sort of malarkey -- and if not you, someone in your family.

If Dante were alive today he would create a 10th circle of hell for the shameless promulgators os such stuff.

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16. Anonymous BMS Researcher on March 22, 2011 6:40 PM writes...

> Given what the immune system's capable of when cranked up a bit

http://en.wikipedia.org/wiki/TGN1412

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17. Anonymous BMS Researcher on March 22, 2011 7:04 PM writes...

@luysii

I personally have never had a serious and untreatable medical condition, but a number of my friends and relatives have, including some whose diseases were ultimately fatal. They are one of the reasons I do what I do. People who work for pharmaceutical companies get all the diseases everybody else gets. At BMS some of the annual awards given to outstanding employees are named in memory of BMS employees who died of conditions for which we don't yet have effective treatments, one of whom I knew pretty well.

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18. Pharmaheretic on March 22, 2011 7:31 PM writes...

@qetzal

Let us see.. COX-2 inhibitors, atypical antipsychotics to treat people with Alzheimer's and ADHD, using anti-epileptics to promote weight loss. Never mind denying common and potentially fatal side-effects of some drugs.

Do cholesterol absorption inhibitors or anti-diabetics (except maybe metformin) have any desirable macro-vascular effects? What about greedy oncologists using inefficacious chemotherapy on terminal cancers or urologists perform prostate removal/radiation seed treatment for low invasive prostate cancer?

Look, if you don't behave ethically most of the time- don't expect people to trust you.

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19. Dale DeWitt on March 22, 2011 8:32 PM writes...

The toxins in the body declaration came from the time tested use of fasting to give the body an extra edge at elimination. Fibrous cleaning and judicious abstinence from heavy food has done well for the skin complexion of people beset with pimples. Pimples or boils can be amplified if inopportune fasting is done in tandem. Many diseases are addressed directly with this semi-dangerous health technique. A sedentary life combined with bad nutrition is a gold mine for unscrupulous drug companies; working in isolation from preventative techniques.

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20. Someone on March 22, 2011 8:44 PM writes...

@Pharmaheretic

"Look, if you don't behave ethically most of the time- don't expect people to trust you."

Where do you get this "most of the time"? I come from a large family and have my share of family members come down with serious and even terminal illness. "Most of the time," actually, all of the time, they try their hardest to treat them in the ways they have been taught and know are best effective. What it comes down to is that the "best" doctors can do sometimes only has a slim chance of working. You must have a mindset that a treatment should equal a cure which it certainly does not.

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21. Jeb Bush on March 23, 2011 4:37 AM writes...

Placebo effect is huge. A lot of these people are probably quite satisfied.

Here in the East, Radio man Don Imus is being treated for prostate cancer under his wife's direction, with roots and berries. Sadly, his wife spends her days out spreading the thimerosal-autism connection.

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22. Me on March 23, 2011 5:12 AM writes...

Concerning herbal therapy (in cultural context), take a look at Wolf D. Storl, he is a bit "spaced-out" but has his points, or Christian R├Ątsch.Both have some books available in English.

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23. Cartesian on March 23, 2011 5:21 AM writes...

Leibniz who did find about energy that e=m.v(squared), was writing about God and honest (he was not a charlatan). But it is true that I did not read that he was proposing any molecule in order to improve health. Thus it was just a precision.

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24. MattF on March 23, 2011 5:52 AM writes...

This is the physicist's 'crackpot index':

http://math.ucr.edu/home/baez/crackpot.html

Key words to look out for are 'energy', 'entropy', and 'non-linear'.

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25. RB Woodweird on March 23, 2011 6:44 AM writes...

But those pads that draw the toxins out through the bottoms of my feet are totally legit, right?

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26. Rick on March 23, 2011 7:27 AM writes...

Lest we feel smug that we are immune to such quackery in our own little bastion of truth and intelligence, I have one word: NEURONTIN. It's hard to read about the history of proliferating indications for neurontin and the supporting "data" without cringing.

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27. Anonymous on March 23, 2011 7:41 AM writes...

Tp paraphrase an old business truism: "If it's too good to be true, then it probably isn't true!"

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28. Will on March 23, 2011 8:01 AM writes...

@ Woodweird

Not if you're wearing socks

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29. Rob on March 23, 2011 8:17 AM writes...

My favorite, though slightly unrelated example, was the "all natural" ice cream that "had no chemicals in it".

With respect to COX-2, chemotherapy, etc - the aim of modern medicine (and regulation by the FDA is part of this process) is to make the best decision possible given the current state of knowledge. They won't be correct all the time, but as long as we re-evaluate based on experimental experience, things will correct themselves. This is a bit more problematic when there isn't a good animal model (Alzheimer's + ADHD because of the effects on human cognition, some cancers because of differences in mouse immune systems, etc). Sometimes the basis for developing a treatment is due to a theory that isn't quite correct (remember proline isomerases as targets for immune suppression because cyclosporins bind to them?). Obviously it's better to find this out before widespread use, but if the problem is pressing, I'd rather try the best scientific guess than throw my hands up and count on placebos and magic. (and yes I've seen close family members go from diagnosis (botched) to chemotherapy, to palliative care to death).

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30. Old Timer on March 23, 2011 8:45 AM writes...

AMAG Pharmaceuticals would be saddened by your distrust of magnets :)

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31. Sticky on March 23, 2011 9:42 AM writes...

My favorite are the little pieces of sticky aluminized mylar that you put on your cell phone to "protect" you from whatever evil things are emitted by your cell phone.

Oh, and paying $69.95 to "Name a star after somebody."

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32. Virgil on March 23, 2011 10:28 AM writes...

On a related note, the laundry detergent industry has been on a similar game for many years, trying to convince us that their concentrated detergents use "less chemicals". Given that a laundry detergent can only ever be composed of 100% chemicals, it is interesting to see their reaction when asked exactly what they're replacing the chemicals with?

BTW, if you want a laugh, check this out...http://www.neogenis.com/

What they're basically selling, is a pill containing beet juice, which contains a lot of nitrate. Now the annoying thing is, there's actually some pretty good clinical trials on sodium nitrate and nitrate going on right now (Ikaria, Theravasc, Ino Therapeutics et. al.), and it does appear to have some benefit for a variety of cardiovascular conditions. The problem is, sites like this dressing it all up in a pseudo-science language, just **** up the entire field for the people actually interested in developing viable therapies based on the good science.

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33. Trottelreiner on March 23, 2011 10:57 AM writes...

> COX-2 inhibitors

They seem to do what they are supposed to do, having the efficacy of unselective COX inhibitors (salicylic acid, a herbal remedy, seems to use this or some related mechanim[1]) without some of the horrendous side effects (again, salicylic acid and its derivatives, ever had the pleasure of taking a relative to hospital because of stomach bleeding?). They have more or less new side effects, and suppressing this data was an ethical low point, but then, can yopu quote any studies that show salix has none of this effects?

> atypical antipsychotics to treat people with Alzheimer's

I agree that this is disgusting, but then, most of the people arguing against this are in the pharmaco-medical complex themselves.

> and ADHD,

Err, WTF? Can you show me any numbers about the usage of antipsychotics in ADHD, besides the moot point that Seroquel and it's ilk are sometimes used as hypnotics, and risperidone is used against aggression in some developmental disorders like autism? BTW, big thank you to the fearmongers for the latter, before that, they used SSRIs in the same population, but there is this nice black box warning since they are known to induce suicidality in depressed children. SSRIs are not fruit drops, but well, ar least preferable to antipsychotics.

Concerning medicalizing children, well, in the good old days, you could toss the from a bridge as a changeling, declare them possesed and exorcise them or just plain execute your own children (the Romans were big at that) when she didn't live up to expectations.

> using anti-epileptics to promote weight loss.

I know of two antiepileptics used in weight loss, and they are somewhat related, topiramate and zonisamide. Both are somewhat related, are somewhat different from most other antiepileptics and are notorious multi-target drugs, which might mean the anorectic and antiepileptic effects are unrelated. And while using anorectics as life-style drugs is problematic, you're aware of the effects obesity has on health issues, and how "execise more, eat less" might not help with some people?

> What about greedy oncologists using inefficacious chemotherapy on terminal cancers

I'm sure you can bolster this claim with statistics. Or not?

Besides, denying treatment to terminal patients, especially when the treatment in question is quite expensive has those nice connotations of putting money over humanity.

> or urologists perform prostate removal/radiation seed treatment for low invasive prostate cancer?

Yeah, that's a problem, again, but since the alternative is medication, it doesn't foster your point.

> Look, if you don't behave ethically most of the time- don't expect people to trust you.

You're aware this cuts both ways, are you? *g*

BTW, funny thing is, most people use their self-image to model other peoples behaviour; so, if some people see corruption, greed and inhonesty everywhere (it might just be plain incompetence, mind your Heinlein), that might raise some questions about themselves; having had my fair share of talking with self-apponted 'alternatives', I think this explains some things.

BTW, how good is your German?

http://www.amazon.de/Entspannt-die-Barbarei-Faschismus-Biozentrismus/dp/3894581484

[1] Acetylsalicylic acid is an irreversible inhibitor of both COX, I'm not that sure if salicylic acid is a real reversible inhibitor of COX, but it seems to interact with is.

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34. Trottelreiner on March 23, 2011 11:07 AM writes...

@ Rob

Funny thing is, there are lots of animal models of ADHD; finding the right one is the problem...

http://www.ncbi.nlm.nih.gov/pubmed/21287324

Medications used in ADHD are most often not antipsychotics, but psychostimulants, e.g. the complete opposite in action:

http://www.ncbi.nlm.nih.gov/pubmed/8873106

But well, concerning our selfprocalimed heretic, if you don't behave ethically, e.g. check your sources...

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35. Vader on March 23, 2011 11:40 AM writes...

"Energy." Heh. Triggered a neuron; hope a slightly tangential anecdote is okay.

Not too long ago, I went to a talk by Temple Grandin at a nearby college. Excellent talk. She comes across as a slightly nerdier than average, more down to earth than average college professor, which (come to think of it) isn't far off the mark. Her talk was on different kinds of minds and it was quite fascinating.

She had a short question and answer session afterwards. This being a fairly liberal small college, some of the questions were ... interesting.

One woman was apparently a New Age animal trainer. She said she could see the "energy" coming off some animals as she worked with them, and asked Ms. Grandin what kind of mind this was.

Ms. Grandin handled it very tactfully. She talked about synesthesia, where one sensation is perceived as different kind of sensation (sounds as colors, and so on.)

I don't think the New Age animal trainer ever caught on that she was being told she was mentally ill.

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36. Cialisize Me on March 23, 2011 6:11 PM writes...

Speaking of vinegar, I got 4 words for you:
"JOGGING IN A JUG" Look it up. Used to see it on store shelves in the SOuth in the 90s. Much easier than actually going jogging. It was a mix of vinegar and some fruit juice and sugar. or something like that. They got sued eventually.

Permalink to Comment

37. Anon on March 24, 2011 3:09 PM writes...

Wanna see an analysis of some good ol' Obamacare cybernetic snake oil?

Behold an Australian evaluation of the very software you are likely to depend on the nexst time you end up in your friendly hospital emergency department.

http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=120&Itemid=116

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38. Brian on March 28, 2011 8:58 AM writes...

You may well have seen this, but the Quackometer goes some way to automatically assessing websites for dodginess:
http://www.quackometer.net/

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39. Tiferet on April 4, 2011 3:36 PM writes...

I recently 'fired' a doctor for insisting that the hormonal medication she wanted to put me on was different from the other medication containing this hormone that have caused me to experience frightening psychiatric side-effects because it was 'natural'. :(

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