Month: June 2016

Ars Medendi reads: The Man Who Couldn’t Stop

I have absolutely no illusions about this blog, and I am fully aware that the majority of the time I’m talking to myself. So I thought it would be worthwhile starting a new feature where I review books I have read. If you are reading this and have yourself read the book I am reviewing, I’d love to hear your thoughts!

 

The Book

The Man Who Couldn’t Stop

David Adam

Picador, 2014

 

What it’s about: A Summary

Broadly speaking, the book is the personal story of our author’s struggle with Obsessive Compulsive Disorder (OCD), interspersed with vital information on the historical, political and medical context of the disease. I adored this book.

It gives a slice of life into the struggles of an OCD sufferer, whilst educating you in an fascinating way that shows you it is more than just a “behavioural quirk”. The straightforward way in which the author reveals his deepest, darkest obsessions is both compelling and incredibly insightful for someone who has never truly understood the disorder before.

It is separated into different sections, each providing a different context for the development of the modern disease model and treatment. The writing style is also of note for its scientific and yet personal nature.

 

On the author

David Adam is a writer and editor of the journal Nature. That he was a correspondent for The Guardian whilst in the thralls of his disorder speaks volumes for his bravery.

 

The Review:

“An Ethiopian schoolgirl names Bira once ate a wall of her house… By the time she was 17 years old she had eaten eight square metres of the wall – more than half a tonne of mud bricks.”

It is hard to explain a mental disorder to one who has not studied medicine, and yet, from this book, I feel as though I have seen through the eyes of a person with OCD. At times hard to read and at others impossible to put down, I found that the take home message was simply that of enlightenment. Enlightening readers that no one is “a little bit OCD”; but that OCD is a serious condition that is frustratingly, and painfully, hard to treat (consider the famous “white bear” experiment referenced throughout this book).

In terms of historical context, the existence of OCD in the religious community, the animal world, and the difficulty of its treatment even up to the current day are explored. The grisly chapter on lobotomies is particularly striking, with almost unbelievable tales of “brains irreversibly damaged by cavalier surgeons armed with nothing more precise than knitting needles”.

These contextual sections at times descend into an Oliver Sacks-like description of patient cases, which is incredibly compelling (amongst the more well-known being Phineas Gage and the Collyer brothers). Also of note is the amusing use of paradoxical Freudian psychoanalyses, encouraging OCD sufferers to obsess more deeply into their intrusive thought, as a more “successful” early treatment.

The book also chronicles evolutions of diagnosis, and how it is essential that we consider such psychiatric disorders on a sliding scale rather than as black-or-white diagnoses. Also key to consider is the importance of personalised medicine, and further research into the use of behavioural therapies as well as drugs to treat patients where it is not possible to pinpoint something “physically” wrong.

I recommend this book to anyone curious about OCD or any psychiatric disorder.

 

A note from the author: As my posts sometimes touch on emotive subjects, comments are disabled after 14 days. This is because, at this stage, I feel that ongoing discussions tend to stagnate.

Let’s have a talk about homeopathy

A note from the author: As this is an emotive subject, comments are disabled after 4 days. This is because, at this stage, I feel that ongoing discussions tend to stagnate.

 

As my first post in a very, very long while, I thought I’d post an extended discussion about some aspects of homeopathy.

Homeopathy is an alternative medicine (as stated in Tim Minchin’s famous song), based on the theory that “like cures like”.(1) This means that “a substance taken in small amounts will cure the same symptoms it causes if it were taken in large amounts”.(2-5)

As I work as a research Chemist, I have to state that I am biased when it comes to alternative medicine. To me, science must be evidence-based to have value; and thus medical practice, which is based on the science, should also be inherently evidence-based. By “evidence-based, I mean there is insufficient scientific research to justify the inclusion of homeopathic method in the standard library of standard medical treatments.(4)

However, in order to fully examine the potential of this theory, I believe it is worth discussing some instances where the homeopathic approach might actually be successful. In doing so, perhaps we can find a reason for the use of alternative medicine by so many people.

 

Successes: X-rays

 

In the modern age, cancer treatment is either through the use of chemicals (chemotherapy) or radiation (radiotherapy). X-rays were discovered in 1895, soon after which scientists unlocked their use in therapeutic applications. In 1986, Emil Grubbé (a physician with training in homeopathy) assembled an x-ray machine and used it to treat a recurrent breast carcinoma.(6)

Though unsuccessful at first, Grubbé’s treatments were potentially more successful than others due to his use of lower exposures for less time, and throughout the rest of his life he taught many others his techniques. X-ray radiation therapy today actually uses a “fractionated” process where low doses are administered over a longer course of time to minimise side-effects.(7)

Homeopathic theory in the case of X-rays works because they kill cells. Therefore it stands to reason that a low dose is best to avoid killing the desired cells. Our intrepid homeopathic physician, Grubbé, unfortunately, fell foul of the damage that X-rays can do at higher exposures, and himself had to undergo many surgeries to treat recurrent cancers.

 

Successes: Hay Fever

 

As another example of homeopathic “success”, let’s look at hay fever.(8-11) The majority of people with hay fever can simply avoid the pollen that triggers it in various ways, or take anti-histamines. Those with more sever allergies may be referred to immunotherapy. Immunotherapy is a treatment where the body’s immune system is exposed gradually to increasing levels of the allergen (pollen), such that their immune cells become tolerant.

The reason to only gradually increase the dose is to minimise side-effects, but this does mean that it takes a long time to reach the point at which the patient is “cured”. At this point, they must take maintenance doses to sustain tolerance. It stands to reason, then, that exposure to allergens (at a homeopathic dose) would potentially reduce the symptoms for some hay fever-sufferers as a form of immunotherapy for those with less severe symptoms.

 

Why successful?

 

So what do these two “successes” have in common? Both are situations where the homeopathic approach happens to coincide with what we currently use in medical practice anyway. They work because exposure to X-rays kills cells, and we want that to happen in cancer treatment. Lower doses result in less peripheral cell deaths and thus less side-effects. They work because pollen induces immune cell responses. Lower doses result in less immune cell responses and thus less side-effects (and thus immune cell tolerance). These are both therapies where evidence exists for their success.

 

As Tim Minchin says, “Do you know what they call alternative medicine that’s been proved to work? Medicine.”(1) But that’s not the appeal of homeopathy.

Stripping down the theory, people like homeopathy because it is “natural”, using the same “natural” cause of a disorder to fix it. And they like it because it has few side-effects. Let’s explore these things.

 

The Unfortunate truth

 

Alas, this is where I look less optimistically into homeopathic method. This is because, as a Research Chemist, I am used to spending my days purifying chemicals and diluting them down to acceptable concentrations for use on cells or proteins. Side-effects tend to occur where the given dose of a drug has effects beyond the desirable local effects. The reason that homeopathic remedies have little to no side effects is because the doses are so low as to have no effects in the body.

Dosage

The homeopathic dilution method uses a logarithmic scale, with C being a dilution by 100 and X being a dilution by 10.(12) A 2C dilution is 1 part in 100, repeated twice (so 1 in 1002 final concentration), 6C is 1 part in 100 repeated 6 times (1 in 1006 final concentration). A 10C dilution is 1 part in 10 repeated 10 times (so 1 in 1010 final concentration) etc etc…

As I have never taken a homeopathic remedy, I had a cursory glance at some online shops to see if anything interesting popped up. I found Mercurious Chloride (Calomel, Hg2Cl2 – I will refer to it as Mercurous Chloride, it’s proper chemical name).(14) This is acutely toxic, causes respiratory sensitization and is hazardous to the aquatic environment according to Sigma-Aldrich, but that is not mentioned on homeopathy suppliers’ websites.(13-14) Not to spoil the surprise, but this is likely because of the very small quantities of active ingredients.

Let’s do some Maths. One supplier offers a pack of 160 g of tablets at 6X potency (for £22.35). 6X potency is 1 in 106 – so 0.00016 g of Calomel is in this 160g. From the shop I looked at, each tablet was approximately 0.11 g.

So, per tablet, we are looking at 0.00000011 g of the chemical. This is a tiny, tiny amount.

The amount of mercury in the water supply (determined to be a entirely safe amount that has no effect) is around 1 microgram per litre.(15) So 1 l contains 0.000001 g of the chemical: or, around ten times as much as in a homeopathic tablet. Frankly, this makes it obvious why people claim that homeopathic remedies are placebos (medicines with no therapeutic benefit).

The cost for this 0.00016 g of Mercurous Chloride is also extortionate: considering that 5 g of the pure chemical would cost less than £30, the mark up is therefore more than 2,300,000%. The numbers speak for themselves.

Natural Remedies

I’d also like to briefly step on the issue of “natural sources”. Some Mercury is purified from mined cinnabar (HgS), and this source gives the most “natural” method (the least steps) of Mercurous Chloride production:

Step 1) Cinnabar ore is heated in air and the resulting Mercury vapour is condensed and collected.

Step 2) Mercuric Chloride is formed by adding Hydrochloric acid to this elemental Mercury.

Step 3) This Mercuric Chloride is then reacted with elemental Mercury to form our Mercurous Chloride.

In the modern age, there is an increasing trend to consume “natural” food and to “detox” your body. It therefore stands to reason that people are concerned about putting potentially harmful substances in their body. I completely understand this and I subscribe to keeping a healthy diet. However, it does not apply when it comes to medicine.

Pure chemicals do not occur in nature, and thus natural remedies are not inherently more safe than those prepared in a lab. Chemical intervention is needed in every case to obtain pure substances, whether for purification or (in this case) to actually make the chemical in which we are interested. Regulated homeopathic remedies are always subject to some form of purification before they are sold on. I would be far more concerned about anything unregulated, as you cannot know whether you are consuming something harmful. If the mood calls for it, I’ll be happy to discuss the natural vs. natural debate at another time, but I have no time for it here.

 

But what’s the harm?

 

What is the harm indeed? If people are willing to spend lots of money on something that has no effect, then it is their choice.

This has been discussed before, and I don’t want to retread very well-trodden ground, so I’ll just summarise here. Individuals using homeopathic treatments instead of conventional medicine are spending more money for treatments that, more often than not, do not work.

A good book to read on this issue is “Trick of Treatment?: Alternative Medicine on Trial” by Simon Singh and Edzard Ernst. There are also other articles on the same subject such as here.

 

What can we learn from homeopathy?

 

So here’s where I go back to my original thoughts. What is the potential in homeopathy?

The inherent value of alternative therapy is that people are different. Not all people like to be told that there is one, and only one, way of curing your disease or disorder. Being treated by alternative medicine is like being part of an exclusive club, like being a medical hipster – and there are huge online communities dedicated to discussing it. These communities have their own “experts” – people who have tried homeopathic treatments and recommend them to others. Obviously people like to feel like they understand what’s going on in their own life, and health is potentially the most important aspect. And subscribing to alternative therapy is one way of regaining control.

Is it really worth it though? Homeopathy becomes most attractive where patients are at their most vulnerable. Where patients are scared to take a nasty treatment with known side-effects, or when they have no other available treatment. Homeopathy cuts through the jargon of complex medical treatment and uses simplistic theories that anyone can “understand”. But, in doing so, the industry takes advantage of a patient’s vulnerability.

It’s easy to blame your condition on toxic chemicals and unnatural sources. It’s hard to admit that sometimes your body needs outside “unnatural” help in the battle against a disease, especially if it’s a battle you’re losing. But if you broke your leg, you would get it fixed. Internal “breakages” also need medical intervention.

 

Conclusions

 

What is my conclusion? Listen to your doctor. They are trained in treating human diseases and disorders; in fact, they have dedicated their lives to it. Talk to them about your concerns. If they dismiss them, then speak with them more: it’s their job to listen to you. Nowadays medicine is more patient-focussed and doctors should be willing to work with their patients. Doctors will be able to determine where a homeopathic treatment may be appropriate for you, as in the above cases.

If your condition is beyond help with conventional methods, by all means homeopathy may help you. If your conviction is strong enough that a placebo is sufficient, try homeopathy. But really nowadays homeopathic treatment is best alongside conventional medicine: there’s a reason it’s sometimes called complementary medicine.

If you want to try homeopathic treatment, just make sure it’s from a reputable source, and that it’s safe.

 

 

Postscript:

This blog is my opinion only, and it is largely my personal exploration of homeopathy as a treatment. In the case of X-rays, I have compacted an extremely large amount of information into a short space, so please do have a further look at the literature if you are interested! In particular, I would recommend the book “Strange Glow: The Story of Radiation” by Timothy Jorgensen.

Also, I am aware that I did only one calculation for the homeopathic remedies. So here is another, for fun:

 

Homepathic remedy:

Alium cepa (red onion)

160 g, 3X potency, £22.35

3X potency is 1 in 103

This is 0.16 g onion in the 160 g

Each tablet is 0.11 g; so, per tablet, we are looking at 0.00011 g of onion

 

Tesco medium red onion:

1 onion (according to tesco.com) is £0.16, about 220 g

The amount in one tablet is therefore one two millionth of an onion.

The mark up for this remedy is therefore 19,000,000%.

And another, as requested:

Homepathic remedy: Weleda Sulphur 30c 125 Tablets

125 tablets, at £0.05 per 100 mg tablet
30C potency is 1 in 100 to the power of 30
This is 1 x 10^-61 g of sulphur in each tablet

– Please note that the mass of a proton (the smallest chemical element) is 1 x 10^-23 g. This is less than that. This means that, in one tablet of this stuff, there is not even one atom of sulphur present.

Sulphur from Sigma-Aldrich (chemical company):

This is £26.50 for 1 kg.
The mark up for this remedy is 2.65 x 10^64 %. Which is 265 with 62 zeroes after it %.

References:

  1. Tim Minchin’s song, Storm: https://www.youtube.com/watch?v=KtYkyB35zkk
  2. British Homeopathic Association Website, accessed 19/06/16: http://www.britishhomeopathic.org/
  3. The Society of Homeopaths’ Website, accessed 19/06/16: http://www.homeopathy-soh.org/
  4. Science and Technology Committee evidence check on homeopathy, 8th February 2010: http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4502.htm
  5. Homeopathy on NHS choices, accessed 19/06/16: http://www.nhs.uk/conditions/homeopathy/pages/introduction.aspx
  6. Nice article on the use of X-rays in radiation treatment: http://www.pbs.org/newshour/updates/emil-grubbe-first-use-radiation-treat-breast-cancer/
  7. The evolution of cancer treatments: Radiation, accessed 19/06/16: http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-treatment-radiation
  8. Hay fever on NHS choices, accessed 19/06/16: http://www.nhs.uk/Conditions/Hay-fever/Pages/Introduction.aspx
  9. Hay Fever on Allergy UK, accessed 19/06/16: https://www.allergyuk.org/hayfever-and-allergic-rhinitis/hay-fever-and-allergic-rhinitis
  10. Kim LS, Riedlinger JE, Baldwin CM, Hilli L, Khalsa SV, Messer SA, Waters RF (2005). Treatment of seasonal allergic rhinitis using homeopathic preparation of common allergens in the southwest region of the US: a randomized, controlled clinical trial. Annals of Pharmacotherapy; 39:617–624.
  11. Reilly DT, Taylor MA, McSharry C, Aitchison T (1986). Is homeopathy a placebo response? Controlled trial of homeopathic potency, with pollen in hayfever as model. Lancet; ii: 881–885.
  12. Homeopathic preparations, Wikipedia, accessed 19/06/16: https://en.wikipedia.org/wiki/Homeopathy#Preparations_and_treatment
  13. Mercury(I) chloride on Sigma-Aldrich: http://www.sigmaaldrich.com/catalog/product/sial/230405?lang=en&region=GB
  14. Helios homeopathy shop, accessed 19/06/16: https://www.helios.co.uk/shop/mercurius-dulcis
  15. Water purification standards, accessed 19/06/16: http://www.anglianwater.co.uk/_assets/media/Standards_Current.pdf or  http://dwi.defra.gov.uk/consumers/advice-leaflets/standards.pdf