About this Author
College chemistry, 1983
The 2002 Model
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: email@example.com
July 2, 2014
Yesterday's link to the comprehensive list of chemical-free products led to some smiles, but also to some accusations of preaching to the choir, both on my part and on the part of the paper's authors. A manuscript mentioned in the blog section of Nature Chemistry is certainly going to be noticed mostly by chemists, naturally, so I think that everyone responsible knows that this is mainly for some comic relief, rather than any sort of serious attempt to educate the general public. Given the constant barrage of "chemical-free" claims, and what that does to the mood of most chemists who see them, some comedy is welcome once in a while.
But the larger point stands. The commenters here who said, several times, that chemists and the public mean completely different things by the word "chemical" have a point. But let's take a closer look at this for a minute. What this implies (and implies accurately, I'd say) is that for many nonscientists, "chemical" means "something bad or poisonous". And that puts chemists in the position of sounding like they're arguing from the "No True Scotsman" fallacy. We're trying to say that everything is a chemical, and that they range from vital to harmless to poisonous (at some dose) and everything in between. But this can sound like special pleading to someone who's not a scientist, as if we're claiming all the good stuff for our side and disavowing the nasty ones as "Not the kind of chemical we were talking about". (Of course, the lay definition of chemical does this, with the sign flipped: the nasty things are "chemicals", and the non-nasty ones are. . .well, something else. Food, natural stuff, something, but not a chemical, because chemicals are nasty).
So I think it's true that approaches that start off by arguing the definition of "chemical" are doomed. It reminds me of something you see in online political arguments once in a while - someone will say something about anti-Semitism in an Arab country, and likely as not, some other genius will step in with the utterly useless point that it's definitionally impossible, you see, for an Arab to be an anti-Semite, because technically the Arabs are also a Semitic people! Ah-hah! What that's supposed to accomplish has always been a mystery to me, but I fear that attempts to redefine that word "chemical" are in the same category, no matter how teeth-grinding I find that situation to be.
The only thing I've done in this line, when discussing this sort of thing one-on-one, is to go ahead and mention that to a chemist, everything that's made out of atoms is pretty much a "chemical", and that we don't use the word to distinguish between the ones that we like and the ones that we don't. I've used that to bring up the circular nature of some of the arguments on the opposite side: someone's against a chemical ingredient because it's toxic, and they know it's toxic because it's a chemical ingredient. If it were "natural", things would be different.
That's the point to drop in the classic line about cyanide and botulism being all-natural, too. You don't do that just to score some sort of debating point, though, satisfying though that may be - I try not to introduce that one with a flourish of the sword point. No, I think you want to come in with a slightly regretful "Well, here's the problem. . ." approach. The idea, I'd say, is to introduce the concept of there being a continuum of toxicity out there, one that doesn't distinguish between man-made compounds and natural ones.
The next step after that is the fundamental toxicological idea that the dose makes the poison, but I think it's only effective to bring that up after this earlier point has been made. Otherwise, it sounds like special pleading again: "Oh, well, yeah, that's a deadly poison, but a little bit of it probably won't hurt you. Much." My favorite example in this line is selenium. It's simultaneously a vital trace nutrient and a poison, all depending on the dose, and I think a lot of people might improve their thinking on these topics if they tried to integrate that possibility into their views of the world.
Because it's clear that a lot of people don't have room for it right now. The common view is that the world is divided into two categories of stuff: the natural, made by living things, and the unnatural, made by humans (mostly chemists, dang them). You even see this scheme applied to inorganic chemistry: you can find people out there selling makeup and nutritional supplements who charge a premium for things like calcium carbonate when it's a "natural mineral", as opposed (apparently) to that nasty sludge that comes out of the vats down at the chemical plant. (This is also one of the reasons why arguing about the chemist's definition of "organic" is even more of a losing position than arguing about the word "chemical").
There's a religious (or at least quasi-religious) aspect to all this, which makes the arguments emotional and hard to win by appeals to reason. That worldview I describe is a dualist, Manichean one: there are forces of good, and there are forces of evil, and you have to choose sides, don't you? It's sort of assumed that the "natural" world is all of a piece: living creatures are always better off with natural things. They're better; they're what living creatures are meant to consume and be surrounded by. Anything else is ersatz, a defective substitute for the real thing, and quite possibly an outright work of evil by those forces on the other side.
Note that we're heading into some very deep things in many human cultures here, which is another reason that this is never an easy or simple argument to have. That split between natural and unnatural means that there was a time, before all this industrial horror, when people lived in the natural state. They never encountered anything artificial, because there was no such thing in the world. Now, a great number of cultures have a "Golden Age" myth, that distant time when everything was so much better - more pure, somehow, before things became corrupted into their present regrettable state. The Garden of Eden is the aspect this takes in the Christian religion, but you find similar things in many other traditions. (Interestingly, this often takes the form of an ancient age when humans spoke directly with the gods, in whatever form they took, which is one of the things that led Julian Jaynes to his fascinating, although probably unprovable hypotheses in The Origin of Consciousness in the Breakdown of the Bicameral Mind).
This Prelapsarian strain of thinking permeates the all-natural chemical-free worldview. There was a time when food and human health were so much better, and industrial civilization has messed it all up. We're surrounded by man-made toxins and horrible substitutes for real food, and we've lost the true path. It's no wonder that there's all this cancer and diabetes and autism and everything: no one ever used to get those things. Note the followup to this line of thought: someone did this to us. The more hard-core believers in this worldview are actually furious at what they see as the casual, deliberate poisoning of the entire population. The forces of evil, indeed.
And there are enough small reinforcing bars of truth to make all of this hold together quite well. There's no doubt that industrial poisons have sickened vast numbers of people in the past: mercury is just the first one that's come to mind. (I'm tempted to point out that mercury and its salts, by the standards of the cosmetics and supplements industries, are most certainly some of those all-natural minerals, but let that pass for now). We've learned more about waste disposal, occupational exposure, and what can go into food, but there have been horrible incidents that live on vividly in the imagination. And civilization itself didn't necessarily go about increasing health and lifespan for quite a while, as the statistics assembled in Gregory Clark's A Farewell to Alms make clear. In fact, for centuries, living in cities was associated with shorter lifespans and higher mortality. We've turned a lot of corners, but it's been comparatively recently.
And on the topic of "comparatively recently", there's one more factor at work that I'd like to bring up. The "chemical free" view of the world has the virtue of simplicity (and indeed, sees simplicity as a virtue itself). Want to stay healthy? Simple. Don't eat things with chemicals in them. Want to know if something is the right thing to eat, drink, wear, etc.? Simple: is it natural or not? This is another thing that makes some people who argue for this view so vehement - it's not hard, it's right in front of you, and why can't you see the right way of living when it's so, so. . .simple? Arguing against that, from a scientific point of view, puts a person at several disadvantages. You necessarily have to come in with all these complications and qualifying statements, trying to show how things are actually different than they look. That sounds like more special pleading, for one thing, and it's especially ineffective against a way of thinking that often leans toward thinking that the more direct, simple, and obvious something is, the more likely it is to be correct.
That's actually the default way of human thinking, when you get down to it, which is the problem. Science, and the scientific worldview, are unnatural things, and I don't mean that just in the whole-grain no-additives sense of "natural". I mean that they do not come to most people as a normal consequence of their experience and habits of thought. A bit of it does: "Hey, every time I do X, Y seems to happen". But where that line of thinking takes you starts to feel very odd very quickly. You start finding out that the physical world is a lot more complicated than it looks, that "after" does not necessarily mean "because", and that all rules of thumb break down eventually (and usually without warning). You find that math, of all things, seems to be the language that the universe is written in (or at least a very good approximation to it), and that's not exactly an obvious concept, either. You find that many of the most important things in that physical world are invisible to our senses, and not necessarily in a reassuring way, or in a way that even makes much sense at all at first. (Magical explanations of invisible forces at least follow human intuitions). It's no wonder that scientific thinking took such a long, long time to ever catch on in human history. I still sometimes think that it's only tolerated because it brings results.
So there are plenty of reasons why it's hard to effectively argue against the all-natural chemical-free worldview. You're asking your audience to accept a number of things that don't make much sense to them, and what's worse, many of these things look like rhetorical tricks at best and active (even actively evil) attempts to mislead them at worst. And all in the service of something that many of them are predisposed to regard as suspicious even from the start. It's uphill all the way.
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July 1, 2014
Here's a comprehensive review of chemical-free consumer products, courtesy of Nature Chemistry. I'm flattered to have been listed as a potential referee for this manuscript, which truly does provide the most complete list possible of chemical-free cleaners, cosmetics, and every other class of commercially available product.
Along similar lines, I can also recommend this site as an accurate, clearly stated summary of the evidence for vaccines causing autism. These are important topics that many people are interested in, and good information is essential.
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June 20, 2014
I wanted to point out an excellent editorial on the whole "Right to Try" issue at Nature. The authors note correctly that stem cells are the therapeutic area where these battles are being fought most often, since their regulatory status (particularly with any sort of autologous cell treatment) is sometimes unclear, the number of possible treatments (well-intentioned and otherwise) is huge, and the medical need is even bigger.
Many countries have made such experimental stem cell treatments more widely available without proof of efficacy. We're not just talking about the usual "medical tourism" list, although those countries are certainly on this one, but places like Japan and Australia. That cuts both ways. Proponents of the idea say that these countries are making more progress than the US for this reason, but a look at what's happened since these regulations were loosened isn't always encouraging. It's very, very, hard to open up such trials without opening them up to the sort of people who will gladly exploit patients for as long as possible without caring if any efficacy is ever proven or not.
Even the idea of putting products up for sale and into consumers' bodies on the basis of phase I data is disturbing. Early-stage clinical trials reveal only whether a product is safe enough for continued testing, not for widespread use. Some 80% of products that make it through phase I clinical trials fail in later studies — about half of those proving to be insufficiently effective and one-fifth insufficiently safe.
When test subjects are paying for the product under investigation, establishing efficacy is hard: controls, randomization, masking and other hallmarks of clinical research break down. Many stem-cell clinics offer their procedures for disparate conditions, further complicating post-market studies.
Under the guise of 'patient-funded clinical trials', clinics in the United States and Mexico persuade people who are seriously ill to pay tens of thousands of dollars for procedures. Because such patients have been told that a product is experimental, they have little recourse when hoped-for cures fail to materialize. Companies can thus profit from selling hope. With their products already on the market, they have little reason to conduct rigorous, conclusive research.
Stem cells, as has been said many times on this side, are surely one of the most overhyped areas in all of medical research. This has been true for at least ten years now, and the hype does not die down. Some may remember that this was an issue during the 2004 presidential election. I'll bet if you took a poll back then and asked where the field would be by 2014, that the general public would have bet on it being much more advanced than it is now. The usual reason applies: it's because this area of research is extremely, inhumanly complicated and difficult, but people get tired of hearing that and think that it's an excuse for some other factor.
There are libertarian and free-market groups behind several of the legal initiatives in the US, who honestly believe that the current FDA structure is an impediment to medical progress, and that this sort of deregulation will end up helping more people more quickly. I believe that their motives are sincere - not everyone pushing these ideas is looking for a quick buck. But the people who aren't need to look around and realize how many quick-buck artists are surrounding them. Every libertarian reform needs to have someone thinking "OK, less regulation and more freedom of choice, check. But what are the ways that this could be abused by unscrupulous SOBs? Can those abuses mount up to where they cancel out the good that's done on the other end?"
In this case, I think that danger is very real, and very likely. As opposed to the caricatures that you hear from people on the left end of the political spectrum, many free-market types, in my experience, have good hearts. Perhaps too good, in some cases. It would never occur to them personally to immediately turn around and use this newly loosened regulatory environment to start looting desperately ill people of their money. But it sure would occur to some others. Homo homini lupus: man is a wolf to man.
+ TrackBacks (0) | Category: Clinical Trials | Regulatory Affairs | Snake Oil
June 11, 2014
I noticed some links to this post showing up on my Twitter feed over the weekend, and I wanted to be sure to mention it. There's a recipe for "all-natural" herbicide that goes around Facebook, etc., where you mix salt, vinegar, and bit of soap, so Andrew Kniss sits down and does some basic toxicology versus glyphosate. The salt-and-vinegar mix will work, it seems, especially on small weeds, but it's more persistent in the soil and its ingredients have higher mammalian toxicity (which I'm pretty sure is the opposite of what people expect).
I hope this one makes a few people think, but I always wonder. The sorts of people who need this most are the ones least likely the read it, and the ones most likely to immediately discount it as "Monsanto shill propaganda" or the like. I had email like that last time I wrote about glyphosate (the second link above) - people asking me how much Monsanto was paying me and so on. And these people are also not interested in hearing about any LD50 data (which they probably assume is all faked, anyway). They're ready to tell you about long-term cancer and everything else (not that there's any evidence for that, either).
Going after this sort of thing is a duty, but an endless chore. I was also sent a link to an interview with some actress where she talks about her all-natural beauty regimen - so pure and green and holistic, and so very expensive, from what I could see. One of the things she advocated was clay. No, not for your skin. To eat it. It has, she explained, "negative charge" so it picks up "negative isotopes". Yeah boy. You'll have heard of those, maybe the last time you were And of course, it also picks up all those heavy metal toxins your body is swimming in, which is why a friend of hers told her that she tried the clay, and like, when she went to the bathroom it like, smelled like metal. I am not making any of this up. A few comments on that site, gratifyingly, wondered if there was any actual evidence for that clay stuff, but most of them were just having spasms of delight over the whole thing (and trading obscure, expensive sources for the all-natural lifestyle). So there's a lot of catching up to do.
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April 15, 2014
This study has implications for many fields of science where its practitioners keep running into rumor and conspiracy theories. The authors tried several different means to increase the uptake of the MMR vaccine (information about the lack of connection with autism, information about the severity of the diseases being pervented, case histories of children who'd had them, and so on), and compared them to see if anything helped with parent who were skeptical of having their children vaccinated.
You can probably guess: none of these helped at all. In fact, several of the interventions appeared to make things even worse, reinforcing beliefs in the dangers of vaccination. There's a general principle at work here, which I've heard stated as "You can't use reason to talk someone out of a position that they didn't arrive at by reason". It's the wrong tool for the job, like using a screwdriver to pull nails. I'd also note that people who are suspicious of vaccines are also likely to be alert to signs that someone is trying to convince them otherwise, and will react accordingly. They know that their position is a minority one - that's part of the attraction, in many cases.
"Here, read this pamphlet from the CDC" is a strategy with no hope whatsoever of working. The case-history approach was probably a better idea, but just the fact that it's coming from some official medical source is enough, in these cases, to discredit it completely. That's what they want you to think. In the context of this blog, I run into this sort of thinking most often in the form of "Big Pharma doesn't want to cure anything", or even "Big Pharma knows how to cure cancer, but doesn't want to tell anyone because it would hurt their profits". The only way I've ever made any headway with that one (and it hasn't been very often) is when I've had a chance to go one-on-one with a believer. Looking someone in the eye and asking them if they really are accusing me of watching some of my family members die from diabetes, cancer, and heart disease while I was hiding the cures and collecting my paycheck is an uncomfortable conversation, but I've had it a few times. The only counterattack has been that no, they're not saying that I personally have these things in my desk drawer, it's the higher-ups, you know, them. "So how have I been working on these diseases for 25 years without rediscovering any of these cures?" I ask, and that generally winds things up. But I like to think (or to kid myself) that I've planted a slight seed of doubt.
You need as much conviction in your voice as the quacks have, though, and that's not easy, because they have a lot. Science has the evidence on its side, naturally, and that's a lot, but conspiracy theorists and their friends have something to believe in, and that's a very strong part of human nature indeed. It is not satisfied by contemplating charts or tables; it does not find fulfillment in double-blinded trials. It provides a ward against fear, the comfort of knowing secrets that others don't, and a fellowship of like-minded believers. In many cases, when you're trying to persuade someone out of these views, you're not just trying to argue a specific point - you're trying to talk them out of an entire worldview. CDC pamphlets don't stand a chance.
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March 26, 2014