« Older Entries

Before ether was a potent painkiller, it was a hit with revellers

painThe marble and granite statue in the Boston Common depicts a physician in medieval clothing holding a cloth next to the face of a man who seems to have passed out. An inscription on the base of the statue reads “To commemorate that the inhaling of ether causes insensibility to pain, first proved to the world at the Mass. General Hospital in Boston, October A.D. 1846.” No names are mentioned.

It was on Oct. 16, 1846, that dentist William Morton ushered in the era of surgical anesthesia by putting printer Gilbert Abbot to sleep with fumes of ether from an inhaler he had devised. Surgeon John Collins Warren then proceeded to remove a tumour from the patient’s neck without any of the usual screaming or thrashing about.

Warren looked up at the doctors who had witnessed the event in the surgical theatre that would become known as the “ether dome” and proclaimed, “Gentlemen, this is no humbug.”

That was in reference to a failed attempt by another dentist, Horace Wells, to demonstrate anesthesia with nitrous oxide, or laughing gas, at the same hospital. In that case, Wells hadn’t waited long enough for the nitrous oxide to take effect and the patient howled in pain as Wells attempted to extract a tooth. He exited in disgrace to the cries of “humbug.”

Although Morton gets credit for the first organized demonstration of ether anesthesia, he certainly was not the first to experiment with the chemical. The sleep-inducing effect of ether was first recorded 300 years earlier, when famed Swiss alchemist, philosopher and physician Paracelsus noted that its vapours would induce a state of unresponsiveness in chickens. Ether does not occur in nature, so where did Paracelsus get it?

In 1540, German physician and botanist Valerius Cordus discovered that heating alcohol with sulphuric acid, then known as oil of vitriol, yielded a new highly flammable substance with a characteristic smell. Vitriol was the archaic name for compounds that today are termed “sulphates.”

Cordus discovered that heating a solution of green vitriol, or iron (II) sulphate, a naturally occurring mineral, yielded “oil of vitriol.” Then in the 17th century, German-Dutch chemist Johann Glauber found that burning sulphur with saltpetre (potassium nitrate) produced sulphuric acid.

Potassium nitrate decomposes to yield the oxygen needed to convert sulphur to sulphur trioxide, which dissolves in water to produce sulphuric acid. In the 19th century, potassium nitrate was replaced by vanadium pentoxide, which acted as a catalyst allowing for easier production of sulphur trioxide. This was the method used to produce the sulphuric acid needed for the synthesis of ether in the 1800s.

Before ether’s triumphant performance in 1846 at Massachusetts General, it had developed a reputation as a recreational substance. Middle-class partygoers and medical students both in Europe and America frolicked under the influence of ether. More curiously, drinking ether was common in Europe and was particularly popular in Ireland, where the Catholic Church promoted abstinence from alcohol and asked people to pledge not to drink alcohol. Drinking ether was a way to get around the pledge. Ether was sold in pubs and shops until the 1890s, when it was classified as a poison.

Dr. Crawford Long had taken part in ether frolics as a medical student at the University of Pennsylvania, and when he took over a rural medical practice in Georgia in 1841, he recalled that ether frolickers sometimes developed bumps and bruises of which they seemed to be oblivious.

Could ether be used to relieve pain, he now wondered? The answer came when he delivered his wife’s second baby with the aid of ether anesthesia. Long went on to perform a painless dental extraction, and in 1842 used an ether-soaked towel to put James Venable to sleep before proceeding to excise two tumours from his neck. But Long was not an academic, was not interested in publishing, nor did he crave fame or fortune.

It was two years after William Morton’s celebrated demonstration that Long documented his efforts in the Southern Medical and Surgical Journal in a paper titled “An account of the first use of Sulphuric Ether by Inhalation as an Anaesthetic in Surgical Operations.”

He described a number of cases, including the amputation of two fingers of a boy who was etherized during one procedure and not the other. Long reported that the patient suffered terribly without ether but was insensible with it. The reason he had waited to publish, he said, was the need to overcome criticism by local colleagues, who had suggested that the ether effect was just an example of mesmerism, which at the time was promoted as a pain-reduction method.

With his publication, Long added his name to the list of people claiming to have been the inventors of ether anesthesia. There was William Morton, of course, and Charles Jackson, a physician who had given up medicine to establish a private laboratory for analytical chemistry, where he also taught students, including Morton, who had come to expand his scientific knowledge.

Jackson claimed that he had introduced Morton to ether anesthesia, and the two got involved in a rancorous battle for years. There was also a Berkshire Medical College student, William E. Clarke, who claimed he had first used ether to put patients to sleep.

It was because of the controversy that the Boston monument does not bear the name of any of the claimants. But it does bear a biblical quote from Isaiah: “This also cometh forth from the Lord of Hosts which is wonderful and excellent in working,” addressing the worry people had that relief of pain was somehow interfering with God’s will.

The quote suggests that medical intervention is itself a gift from God and is backed up by a relief on the statue depicting a woman who represents Science Triumphant sitting atop a throne of test tubes, burners and distillers, with a Madonna and Child looking on with approval. There is also a Civil War scene on the side of the monument with a Union field surgeon standing ready to amputate a wounded soldier’s leg. The soldier sleeps peacefully. Thanks to ether, he would feel no pain.

 

Dr. Joe Schwarcz

Chemistry Lesson for the Food Babe…and everyone else #8

vani hariI wonder if Ms. Hari would ever consider taking aspirin. If she found out that it is made from petroleum, probably not. For some reason she considers petroleum to be a substance that comes from hell. It is a common misconception that aspirin is produced from the bark of the willow tree. In fact, the starting material for the chemical synthesis of aspirin is benzene, derived from petroleum. This is then converted to phenol which in turn is converted to salicylic acid which is then converted to acetylsalicylic acid or ASA, which we know as aspirin.

While aspirin is not made from willow bark, there is a connection. The bark of the white willow contains salicin, a chemical that, like aspirin, has an effect on pain, fever, inflammation and blood clotting. The Ebers papyrus, an Egyptian medical text dating back to the sixteenth century BC describes the use of the bark of the willow tree to treat pain, fever and conditions that today we would describe as inflammatory. In the fifth century BC, Hippocrates recommended willow bark preparations to reduce fever and ease the pain of childbirth.

But the problem with willow bark extracts is that the active ingredient they generated on ingestion, salicylic acid, irritates the stomach, often causing ulcers. It was the search for a modified form of salicylic acid that eventually led Felix Hoffman, working for the German pharmaceutical company, Bayer, to come up with acetylsalicylic acid. It was a great improvement over willow bark extract because it caused much less stomach irritation, and since it was a pure compound, dosages could be properly controlled. Curiously, willow bark extract is now sold in health food stores as a “natural alternative” to aspirin. Ms. Hari might prefer it since it is “natural” and not made from petroleum. As for me, the “natural is better” fallacy gives me a headache. But I know what to take for it. Synthetic acetylsalicylic acid.

Joe Schwarcz PhD

Food Babe Lesson #3

vani hariIn our continuing, but extremely challenging effort to educate the Food Babe on science, let us pick on a grapefruit.

“A chance finding of our study on ethanol-drug interactions was that citrus fruit juices may greatly augment the bioavailability of some drugs.” So began a paper published in 1991 in The Lancet, one of the most respected medical journals in the world. Dr. David Bailey and colleagues at the University of Western Ontario had been studying felodipine, a blood pressure–lowering drug, and wondered if it interacted with alcohol. They decided on a double-blind trial in which some subjects were to take the drug with alcohol and some without. This meant that the taste of alcohol had to be masked, and after some experimentation Dr. Bailey concluded that grapefruit juice was up to the task. To the researchers’ surprise, the alcohol had no effect, but in both groups the blood levels of felodipine were three times higher than expected. Bailey knew he was on to something.

It turned out that some compound specific to grapefruit inhibited the action of CYP3A4, an enzyme found in the wall of the intestine. This enzyme is part of the body’s detoxicating system and tackles intruders, such as medications. If its action is impaired, blood levels of these foreign substances can be expected to rise. Since CYP3A4 is known to be involved in the metabolism of numerous drugs, researchers suspected that felodipine would not be the sole medication to show a “grapefruit effect.” Indeed it was not. Various oral medications, ranging from heart-rhythm regulators and immunosuppressants to estrogen supplements and AIDS treatments, all interact with grapefruit juice. And the effect can last as long as 24 hours, meaning that drinking grapefruit juice at any time is contraindicated when taking drugs metabolized by CYP3A4. Since it isn’t completely clear which drugs fall into this category and which do not, and because of the known variation in CYP3A4 levels in different individuals, some experts suggest that grapefruit juice be avoided when taking any medication. Accordingly, many hospitals have taken grapefruit juice off the menu.

Grapefruit is not the only food to be involved in a drug-food interaction. Dairy foods can interfere with some antibiotics, broccoli can reduce the effect of anticoagulants, foods high in tyramine (aged cheese, red wine, soy sauce, sauerkraut, salami) can cause dramatic rises in blood pressure when coupled with antidepressants of the monoamine oxidase (MAO) inhibitor variety, and the absorption of digoxin (taken for congestive heart disease) is impaired by cereals such as oatmeal. And oh, all these interactions involve “natural” foods.

 

Dr. Joe Schwarcz

A rather remarkable coincidence!

ShulginMy column this week is about Alexander Shulgin, the chemist who synthesized a number of mind-altering drugs which unfortunately sometimes became subjects of abuse. My column was submitted last Sunday and a couple days later we had that bizarre story emerge from Germany with a bunch of homeopaths suffering an overdose of one of Shulgin’s compounds. It still isn’t clear what happened there. Were they involved in some ridiculous homeopathic “proving” or did someone spike their food or drink? It will be interesting to find out. In any case, the last sentence of my column turned out to be somewhat prophetic.

Chemist’s curiosity led him to synthesize mind-altering substances

“I’m curious!” That was Alexander Shulgin’s simple answer to the question of why he had dedicated much of his life to the exploration of psychedelic drugs. The American chemist who died in 2014 at the age of 88 was famous not only for synthesizing a large number of mind-altering substances but also for experimenting with them on himself, his wife and friends. He worked within the context of existing laws because the compounds he synthesized had not existed before and therefore were legal at the time he made them. Dr. Shulgin never intended his creations to be used as “street drugs;” his interest was in researching the effects of chemicals on the mind. Nevertheless, many of the drugs he created became the subject of abuse and were eventually made illegal. Perhaps the best known of these is Ecstasy, which had actually been patented by Merck back in 1914, but was abandoned because the company could not find a use for it. Shulgin developed a novel synthesis for the drug, and after experimenting on himself, suggested it could be used as a treatment for anxiety. He never intended it to be used as a recreational substance.

Shulgin was interested in chemistry from a young age, but it was surgery for an infection of his thumb that launched his enthusiasm for pharmacology. Prior to the surgery he was been given a glass of orange juice that had some undissolved crystals at the bottom. Convinced he had been given a sedative, he promptly fell asleep. As he was to learn later, the crystals were just sugar and it was his mind that had actually lulled him into sleep. What sort of chemistry was going on in his brain, he wondered? He began to explore the literature of mind altering substances and became interested in the chemistry of mescaline, the active ingredient in the peyote cactus, a plant long used by Native North Americans for spiritual purposes. Eventually he tried mescaline himself and was amazed by the hallucinations it produced.

After obtaining a PhD in biochemistry from the University of California at Berkley, Shulgin was hired by the Dow Chemical company to work on insecticides and came up with Zectran, one of the first biodegradable such products. It turned out to be so profitable that as a reward Dow allowed Shulgin to work on any project of his choosing. He didn’t have to think much about what that would be. Before long he had prepared a number of compounds that were candidates for mind altering effects with therapeutic potential. By this time he had come to learn that many compounds that affected the mind, such as mescaline and amphetamine, shared a common feature in terms of molecular structure. They all had a “phenethylamine” grouping of atoms. When Dow decided against pursuing this line of research, Shulgin left, set up a lab in his home, and began to churn out compounds. Because of the expertise he had acquired on drugs that had a potential for abuse, he developed an interesting relationship with the Drug Enforcement Agency, often giving talks to agents about the identification of such substances. For a while he even had a researcher’s license to produce Schedule 1 drugs, those that have no accepted medical use and have great potential for abuse.

Shulgin did not work in secret; he published numerous scientific papers about the drugs he had made. But as drug abuse became more and more of a problem, he had increasing difficulty in getting his research into the scientific literature. He then decided to release it all in a self-published book written with his wife under the curious title of “PiHKAL.” Readers would learn that it stood for “Phenethylamines I Have Known and Loved.” The book was divided into two sections, with the first being a long-winded story about the couples romance and numerous drug experiences, while the second section was a compilation of the 179 compounds Shulgin had made, including dosages he had used, effects experienced, and details of synthesis. Inevitably this led to abuse, with the book essentially becoming a manual for making drugs that had a potential for doing harm through improper dosage or through impurities introduced by inexperienced chemists. Many of the listed compounds would eventually be made illegal.

There is no question that Alexander Shulgin’s unconventional research methods and his descriptions of the effects of the compounds he synthesized stimulated pharmacological research into drugs, Ecstasy being an example, that may actually have therapeutic potential. But we are still left with the disturbing idea that curiosity sometimes kills the cat.

 

Dr. Joe Schwarcz

“The Great Moment”

PRarely does a single event alter the course of medicine, but that is exactly what happened at Boston’s Massachusetts General Hospital on October 16, 1846 in the surgical theatre that would eventually be christened “The Ether Dome.” Dr. John Collins Warren, having just excised a growth from the neck of a patient rendered unconscious with ether, looked up at the physicians and students who had witnessed the epic event, and declared, “Gentlemen, this is no humbug!”

The onlookers had likely anticipated a duplication of the fiasco that just two years earlier had disgraced dentist Horace Wells who had convinced Warren to allow a demonstration of painless tooth extraction using nitrous oxide. Wells had in his own practice administered the gas successfully on many occasions and gallantly even volunteered to have one of his own teeth extracted to confirm the wondrous properties of “laughing gas.” But in his eagerness to demonstrate the effect, Wells had not allowed enough time for the medical student, who curiously had agreed to be experimented upon, to inhale enough nitrous oxide. An ear shattering scream brought the proceedings to a halt and Wells retreated amidst loud cries of “humbug.”

William Morton had shared a dental practice with Wells and had seen nitrous oxide at work. He wondered if other gases could perform even better. How he happened upon ether would eventually become a matter of much acrimonious debate, but it seems he was put on its trail by Dr. Charles Jackson whose lectures on chemistry Morton attended after giving up dentistry in favour of studying medicine at Harvard. Ether was hardly a novel substance at the time, having been first made in 1540 by the Prussian Valerius Cordus who distilled it from a reaction between alcohol and sulfuric acid. The volatile chemical didn’t get much attention until John Dalton, of atomic theory fame, described it extensively in his 1819 monograph, “Memoir on SulfuricEther.” Shortly after, an anonymous note, believed to have been penned by Michael Faraday, appeared in the Quarterly Journal of Science and the Arts pointing out that the vapours of ether, which some physicians were using at the time to treat respiratory problems, “produces effects similar to nitrous oxide.” Faraday knew all about nitrous oxide from his mentor Humphry Davy who had illustrated its giddiness-inducing effects and sparked a craze of laughing gas parties. These were soon joined by “ether frolics.”

Jackson it seems was familiar with such frolics and had discussed ether with Morton, although there is no evidence he had suggested its use as an anesthetic. He did suggest rubbing the liquid on the gums before pulling a tooth to reduce pain. What is clear, is that Morton began to experiment on insects, fish, his dog and finally on himself. “Delighted with the success of this experiment, I waited impatiently for someone upon whom I could make a fuller trial. A man came in, suffering great pain, and wishing to have a tooth extracted. Saturating my handkerchief with ether, I gave it to him to inhale. He became unconscious almost immediately. It was dark, and Dr. Hayden held the lamp while I extracted a firmly-rooted bicuspid tooth. He recovered in a minute and knew nothing of what had been done for him. This was on the 30th of September, 1846.”

An account of the event in the Boston Daily Journal the next day precipitated a visit to Morton by the eminent surgeon, Dr. Henry J. Bigelow, who after witnessing a number of successful tooth extractions under ether, convinced Dr. Warren to give ether a try. The result was “The Great Moment,” as it was called in a 1944 film that more or less accurately portrayed the story of the discovery of ether anesthesia.

Morton and Jackson fought bitterly over credit for the discovery of ether, oblivious of the fact that in 1842 Dr. Crawford Long, a physician practicing in Georgia, had witnessed a demonstration of “chemistry” with ether and laughing gas by an itinerant showman and made the connection to anesthesia. He amputated a toe under ether but never described his experiments until 1849 at the urging of his friends who regarded him as the true inventor of anesthesia. Indeed, Long may have been the first to use ether, but it was in Morton’s footsteps that others followed, justifying the epitaph on his tombstone “Inventor and Revealer of Anesthetic Inhalation.” When Jackson chanced upon this one day, he apparently went mad and spent his last seven years in an insane asylum.

 

Dr. Joe Schwarcz

Does Hydroquinone Have a Dark Side?

hydroquinoneThey were once mistakenly thought to be caused by a disease of the liver, so they are called “liver spots.” Actually these skin blemishes are caused by a buildup of the skin pigment melanin and are associated with aging and long-term exposure to ultraviolet light. Technically referred to as “Lentigo senilis,” these hyperpigmented spots usually just present a cosmetic problem unless they develop irregular borders and undergo a colour change, in which case they need to be evaluated by a physician. People bothered by such “senile freckles” can look to hydroquinone for help.

When applied as an ingredient in a skin cream, this chemical inhibits the activity of tyrosinase, an enzyme that is necessary for the formation of melanin. This brings up three questions. How well does hydroquinone work, what concentration is needed, and what risks, if any, does its use present? Hydroquinone does work, and its efficacy, as is to be expected, is dose related. Need a minimum of 1% in a cream to see any result, and really significant effects kick in at 4%. In the U.S., hydroquinone is available in over the counter products at concentrations up to 2%, anything more than that requires a prescription. In Europe and in Canada all hydroquinone products require a prescription. Why the difference?

Different regulatory agencies arrive at decisions in different ways. In this case, Europe and Canada look at worst case scenarios while the U.S. evaluates hydroquinone based on its actual use in cosmetics. Rat feeding studies have suggested that hydroquinone may be carcinogenic, although this is contentious. In humans, in rare cases, accidental ingestion of photographic developer fluid containing hydroquinone has resulted in toxic reactions, but in a controlled trial with human volunteers, ingestion of 300-500 mgs daily for months produced no observable effects. As far as topical application goes, no systemic reaction has ever been noted, and no link to skin cancer has ever been found. But there is a chance of skin irritation, especially if sun protection is not used after application, as well as a rarely seen blue discoloration known as “ochronosis.” With higher concentrations there is the possibility of losing too much pigment resulting in white spots. It is mainly for the latter reasons, and some concern that hydroquinone has not been studied with enough rigour, that Canada and Europe are concerned about over-the-counter availability.

But aside from hydroquinone products that have been adulterated with mercury compounds, which has happened in Africa, no significant problems with 2% solutions have cropped up. Hydroquinone also occurs in nature, found in the bearberry, madder and mulberry plants, extracts of which are touted as “natural skin lightening agents.” These do work, but whatever issues arise with hydroquinone apply to these preparations as well. The fact that the hydroquinone comes from a natural source is irrelevant. Basically, 2% hydroquinone preparations, no matter what the source, can reduce age spots effectively and the alarm sounded by some activist organizations about such products is not backed up by evidence.

 

Joe Schwarcz

You Asked: Can the much advertised Lipozene lead to weight loss?

lipozeneThe “active” ingredient in Lipozene is glucomannan, a form of dietary fiber that is extracted from the root of the konjac plant. Fiber, by definition, is any type of food component that cannot be digested and consequently makes its way to the large intestine or colon, where bacteria may break it down into smaller compounds. Most of these, along with intact fiber, are excreted. Glucomannan is made of glucose and mannose molecules joined together in long chains, but unlike digestible carbohydrates like starch, it is resistant to breakdown by our salivary or pancreatic enzymes.

As the indigestible glucomannan sits in the stomach or small bowel before passing on to the colon, it absorbs a great deal of water. This bulky mélange of water and fiber makes for a feeling of fullness and curbs the appetite. There have actually been a few short term studies indicating more efficient weight loss on a low calorie diet when it was combined with about 4 grams of glucomannan per day.

Marketers take such studies and inflate them with hype about easy weight loss. They promise weight loss without the need to diet or exercise. Of course this is a promise that cannot be fulfilled, which is the reason that an American company called Obesity Research Institute was taken to task by the Federal Trade Commission and was made to return 1.5 million dollars to customers who had been victimized by unsubstantiated claims. Two physicians who appeared as “expert endorsers” on infomercials produced by the company were also reprimanded. Seems that money can blur scientific vision.

This is not to say that glucomannan in combination with a low calorie diet and exercise cannot aid in weight loss. It can. But it is not a long term answer to the problem of weight control. This fiber does, however, provide some other possible benefits. It slows the absorption of other carbohydrates into the bloodstream and provides better control of blood glucose. Glucomannan also interferes with cholesterol uptake, so it can lead to lower blood cholesterol. For those in need, it can also be an effective laxative. And if you pop a couple of glucomannan pills before grocery shopping you will feel more full and buy less!

Joe Schwarcz

Why Yet Another Study of Homeopathy?

homeopathy ADHDThis post needs a bit of a background. A few weeks ago we noted that the Dean of Pharmacy at the University of Toronto was organizing a trial on using homeopathic preparations for the treatment of ADHD. A letter to the Dean asking how a Faculty of Pharmacy would get involved in studying something that is dismissed by the vast majority of the scientific community seemed appropriate. Eventually this letter was signed by more than ninety scientists and physicians and was sent off. There was no reply. In our view, not only is this a waste of funds, it adds an aura of respectability to a scientifically bankrupt notion. This is especially disturbing now in face of the measles outbreak since the private clinic where the study is to be carried out is a supporter of “nosodes,” the homeopathic “alternative” to vaccination. The original letter sent to Dr. Boon is reproduced below the following opinion piece that appeared in the Montreal Gazette.

Academic Freedom Comes With Academic Responsibility

Academic freedom is sacrosanct in universities. Researchers must be free to pursue their ideas, be they conventional or peculiar. But academic freedom also includes the freedom of others to question those ideas, and scholastic consideration dictates that those questions be addressed, especially when they are posed in a courteous letter signed by ninety scientists and physicians from around the world, including two Nobel Laureates.
The letter in question was sent to Dr. Heather Boon, Dean of the Leslie Dan Faculty of Pharmacy at the University of Toronto and focused on a study she was organizing to investigate the use of homeopathic preparations in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children. Those of us who signed the letter, along with the vast majority of the scientific community, believe that numerous studies have concluded that the effects of homeopathy do not extend beyond a placebo response. The letter sought Dr. Boon’s views on why a Faculty of Pharmacy was organizing a trial that legitimizes homeopathy, a practice that has no scientific plausibility.
Homeopathy is not an umbrella term for alternative modalities. It is a very specific practice that originated before the dawn of the scientific era when little was known about disease or chemistry. Samuel Hahnemann, a well-meaning German physician, concluded that a substance that causes symptoms in a healthy person cures those symptoms in a sick person if it is sufficiently diluted. His process involved thumping the solution into a leather pillow between dilutions, and finally using a drop to impregnate a sugar tablet that would then serve as a “homeopathic medicine,” the term deriving from the Latin for “similar” and “disease.”
Hahnemann could not have realized at the time that the final solution did not contain a single molecule of the original substance. Today, homeopaths have to contend with chemical knowledge and have proposed that the curative effects are to be explained by the sequential dilutions leaving an imprint on the solution, although they appear to be at a loss to explain how such an image is transferred to a sugar pill or how a molecular ghost can have healing properties.
Stymied by the implausibility of nonexistent molecules having therapeutic potential, homeopaths point to papers in the scientific literature demonstrating a larger than placebo effect, as well as to the millions around the world who use homeopathy with satisfaction. Neither of these is surprising. Toss a hundred coins into the air and count heads and tails. Maybe 45 heads, 55 tails. Maybe 48 tails 52 heads. But do this a hundred times, and one event may come out 30 heads and 70 tails. If this is the only one reported, the impression would be that the coins were not fairly weighted. So it is with studies of homeopathy. Just by chance alone, some results will indicate efficacy. That’s why we look at all the studies and come to the conclusion that we are looking at a placebo response, which of course is valuable and should not be dismissed. Indeed, couple the placebo response with the fact that homeopathic treatments are administered by caring people who spend a lot more time with patients than physicians can, and that they mostly target self-limiting conditions or diseases that have their ups and downs, and you have a formula for satisfaction.
ADHD is a serious condition that merits serious research. Apparently the University of Toronto researchers carried out a pilot study involving homeopathy that seemed to indicate benefit. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it essentially meaningless. Even if we were to attach some importance to the claimed reduction of symptoms, the effect was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior. Furthermore the proposed study would use individualized treatments for each subject as determined by a homeopathic consultation, so at best the results would be ambiguous in terms of making any recommendation.
The study is actually to be carried out at the Riverdale Homeopathic Clinic, a private institution that also offers ear candling, cranial sacral therapy and “nosodes,” which are homeopathic versions of vaccines. No public funding is involved; support comes from a foundation dedicated to alternative medicine. Nevertheless, one wonders why with various nutritional and biofeedback treatments with significant potential for helping with ADHD needing exploration, a scientifically insolvent notion is being pursued. One also wonders why a Dean of Pharmacy at a major Canadian Institution did not take the time to respond directly to repeated requests for her comments on a contrary opinion expressed by a large number of notable scientists and physicians.

ORIGINAL LETTER

Dear Dr. Boon

The following originates from the McGill University Office for Science and Society and has been signed by scientists and physicians from the international community. We are all devoted advocates of academic freedom and support the right of researchers to pursue any field of study they feel has merit. But we also feel that it is fair to ask colleagues questions about how a particular study they are engaged in may contribute to the bank of scientific knowledge. It should be emphatically stated that those who have added their name to this letter, including two Nobel Laureates, in no way wish to interfere with your research. Everyone is just interested in your response to the concerns expressed here.
Those concerns deal with the trial we understand you are organizing to investigate a homeopathic approach to the treatment of ADHD. First, let us point out that the McGill Office for Science and Society accepts no funds from any vested interest; our only allegiance is to the scientific method and to evidence-based science. It makes no difference to us whether any substance, including homeopathic products, is regulated or not, as long as the decision is arrived at through proper scientific evaluation rather than emotion, “they say” or pressure from vested interests.
Along with the majority of scientists, we find the notion of nonexistent molecules having a physiological effect through leaving some ghostly impression in water that is then transferable to a sugar pill simply untenable. Even if some sort of “memory” effect prevailed, there is no reasonable explanation for how it could affect biology. Furthermore, after all the sequential dilutions and succussions, the original impurities in the solvent would be more extensively present in the final solution than any component from the original homeopathic source. After evaluating the scientific literature, including a comparison of 110 homeopathic studies with 110 conventional studies for a number of disorders and outcomes, the most likely conclusion is that any benefit attributed to homeopathy can be ascribed to a placebo response.
Generally, scientists look askance at homeopathy, but don’t bother much with it because they consider it to be harmless folly. Unfortunately, this is not the case when homeopaths recommend “nosodes” as alternatives to vaccination, or attack the use of antibiotics for infections, or offer unproven treatments for ADHD.
The reason for this extensive email is to solicit your rationale, given your training as a pharmacist, for the study you are carrying out. Is the motivation a concern that parents are wasting money and possibly sacrificing effective treatment by resorting to homeopathy for ADHD, and that the study may clarify the situation? Or is there a belief that there may be some factor other than a placebo response involved? In that case, what mechanism may be operative?
You allude to the results of a pilot study that warranted this further research. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it highly questionable. You also note that the reduction of symptoms found in the pilot study was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior.
Basically, as you have gathered, we are curious about why, given the need to investigate natural therapies that may actually have a potential for benefit, and faced with a scarcity in funding, a Department of Pharmacy is interested in investigating a subject that has been addressed extensively in the literature and has been found wanting both in evidence and plausibility. There is also a concern that just the mounting of such a study by a highly reputable researcher at a top notch university will be used by homeopaths to justify diverse aspects of their practice, including steering patients away from evidence-based treatments.
Looking forward to your comments,
Regards
Joe Schwarcz
Director, McGill Office for Science and Society

David Harpp
Macdonald Professor of Chemistry
Tomlinson Chair in Science Education

Ariel Fenster
Associate Director, McGill Office for Science and Society
.
Harold Kroto
Francis Eppes Professor of Chemistry
Chemistry and Biochemistry Department
The Florida State University

Roald Hoffmann
Professor of Chemistry
Cornell Unversity

David H. Gorski, MD, PhD, FACS
Chief, Breast Surgery Section
Wayne State University School of Medicine
Managing Editor, Science-Based Medicine

Phil Gold CC, OQ, MD, PhD, FRSC, MACP, FRCP(C)
Douglas G. Cameron Professor of Medicine,
Professor of Physiology and Oncology,
McGill University
Executive Director Clinical Research Centre
McGill University Health Centre

Nahum Sonenberg, FRS
McGill University
Department of Biochemistry
Goodman Cancer Research Center

Brian Alters, PhD, FAAAS
Professor
President, National Center for Science Education
Chapman, Harvard, McGill Universities

Mark Crislip MD
President, Society for Science-Based Medicine

Geoffrey C. Kabat, Ph.D
Cancer Epidemiologist, Dept. of Epidemiology and Population Health
Albert Einstein College of Medicine, Bronx, NY.

David Colquhoun FRS
Professor of pharmacology
University College London, UK

Hon. Kelvin K. Ogilvie, C.M., Ph.D., D.Sc., F.C.I.C., H.col.

Professor Richard M Sharpe FRSE, College of Medicine & Veterinary Medicine
University of Edinburgh, Scotland

Paul A. Offit, MD
Professor of Pediatrics
Division of Infectious Diseases
The Children’s Hospital of Philadelphia

Richard G. Margolese
Professor of surgical oncology
JGH, Montreal

Timothy Caulfield, LLM, FRSC, FCAHS
Canada Research Chair in Health Law & Policy
Trudeau Fellow and Professor, Faculty of Law and School of Public Health
Research Director, Health Law Institute, University of Alberta

Leonard W Fine PhD
Senior Fellow and Scientific Program Officer
Science Foundation Arizona
Professor of Chemistry Emeritus
Columbia University

Haim Abenhaim, MD, MPH, FRCSC
Obstetrician & Gynecologist, Maternal Fetal Medicine Specialist
Associate Professor of Obstetrics & Gynecology
Jewish General Hospital, McGill University

Steven Novella, MD
Assistant Professor of Neurology, Yale University School of Medicine
Executive Editor, Science-Based Medicine

Daniel Lalla, MDCM FCFP
Faculty Lecturer, McGill Family Medicine
Rural site Director, Cowansville Medical Clinic
Physician, BMP Hospital and CHSLD de Cowansville

Seymour Mishkin MDCM, FRCP(C)
Assoc. Prof of Medicine McGill
Senior Physician Royal Victoria Hospital (MUHC)

Richard J. Munz,
Emeritus Professor, Department of Chemical Engineering
McGill University

Dennis Geist
President, Charles Darwin Foundation

Mark Roper MD
Director of the Division of Primary Care at McGill University Health Centre

Bruce M. Shore, Psychologist
Professor Emeritus of Educational Psychology
Fellow of the American Educational Research Association

Janine Mauzeroll,
Associate Professor
Chemistry Department
McGill University

Jacques Derome, FRSC
Emeritus Professor
McGill University

Charles Roth
Professor
Department of Mathematics and Statistics
McGill University

John J. Jonas, O.C., C.Q., FRSC, Ph.D.
Birks Professor of Metallurgy Emeritus
Materials Engineering, McGill University

Arie Benchetrit, MD.
PLASTIC SURGEON
Cosmedica Clinic
1, rue Holiday, suite 813
Pointe-Claire, Qc., H9R 5N3

Kosta Steliou, Ph.D.
Chairman & CEO, PhenoMatriX, Inc.
Professor Emeritus of Chemistry Research Professor Emeritus of Pharmacology Professor, Cancer Center, Boston University School of Medicine

David S. Rosenblatt, MD
Holder, Dodd Q. Chu and Family Chair in Medical Genetics
Professor, Departments of Human Genetics, Medicine, Pediatrics, and Biology
McGill University

Josh Bloom, Ph.D.
Director of Chemical and Pharmaceutical Science
American Council on Science and Health
New York, NY

Edith Zorychta, PhD
Associate Professor,
Departments of Pathology, Pharmacology and Therapeutics.
Director of Graduate and Postdoctoral Studies,
Department of Pathology
McGill University

John Richardson, MDCM, FRCP(C), PhD
Professor,
Departments of Pathology, Neurology and Neurosurgery,
Miranda Fraser Chair in Comparative Pathology
McGill University

Olivia Jensen
Professor, Geophysics
Department of Earth and Planetary Sciences
McGill University

Yoni Freedhoff MD
Medical Director, Bariatric Medical Institute
Assistant Professor, Department of Medicine, University of Ottawa

Terry Polevoy, MD, FRCP(C)
QuackeryWatch.com

Ivan Rohan MD
Director of Continuing Medical Education
Department of Family Medicine
McGill University

Henry Leighton, Professor Emeritus
Department of Atmospheric and Oceanic Sciences
McGill University

James Fresco PhD
Professor of Chemistry (retired)
McGill University

Harriet A. Hall, MD
Co-Editor, Science-Based Medicine

Christopher Labos MD CM, MSc, FRCPC

George B. Kauffman
Professor of Chemistry
California State University, Fresno
Fresno, CA 93740-8034
USA

Lorne Trottier, M. Eng
Co-founder Matrox Corporation

Richard Koestner
Professor of Psychology
McGill University

Jack Hoffman
Pharmacist, Montreal

Mark Yaffe MDCM
Professor, Department of Family Medicine
McGill University

Michael Rosengarten B. Eng. M.D.
Adjunct professor of medicine McGill University

Linda Reven
Professor of Chemistry
McGill University

Youla Tsantrizos
Professor of Chemistry
McGill University

Jeffrey L. Derevensky
Department of Educational & Counselling Psychology
Professor, School/Applied Child Psychology
Professor, Psychiatry

J. (Quim) Madrenas, MD, PhD, FCAHS
Canada Research Chair in Human Immunology
Professor and Chairman
Department of Microbiology & Immunology
Director, Microbiome and Disease Tolerance Centre
McGill University
Executive Director, CIHR Human Immunology Network

Lee Wohl BPharm, MBA
Clinical pharmacist, Montreal

Stephen Barrett M.D.
Quackwatch.org

Steven R. Shaw, Ph.D.
McGill University
Director, Resilience, Pediatric Psychology, and Neurogenetics Connections Lab
Editor, School Psychology Forum

Alvin Shrier PhD
Hosmer Chair and ProfessorDepartment of Physiology
Director, Cell Information Systems
Bellini BuildingMcGill University Life Sciences Complex

John Harrod
Professor of Chemistry (Emeritus)
McGill University

Scott Bohle
Professor of Chemistry
McGill University

John M. Dealy, FRSC
Professor Emeritus
Department of Chemical Engineering
McGill University

Abraham Fuks MD
Professor of Medicine
McGill University

Prof. Alan McHughen, D.Phil.
University of California,
Riverside, Ca.

David Ronis
Professor of Chemistry
McGill University

Ann Wechsler
Professor of Physiology
McGill University

James P. Snyder
Director of Biostructural Research
Emory University
Atlanta, GA

Sondra Sherman, BSc. BFSc. PDt. CDE
Certified diabetes dietitian educator

Jann Johnson Bellamy, J.D.
Tallahassee, Florida

Jonathan Toker PhD
Toker Engineering,
Los Angeles, CA

Ilene Gilbert P. Dt. (Private Practice)

Deborah Schwarcz MDCM, CCFP-EM
Family and Emergency Physician
McGill University Health Center

Hanadi Sleiman
Professor of Chemistry
Canada Research Chair in DNA Nanoscience, Tier I

Masad J. Damha,
James McGill Professor of Chemistry
McGill University

Karl Schwarz MD, MSc, FRCS(C)
Plastic surgeon, Montreal

Dr Alyce Fischer
Dental Surgeon

Leon Glass, FRSC
Isadore Rosenfeld Chair in Cardiology
and Professor of Physiology
McGill University

Miriam Salamon BSc MD CCFP FCFP
Faculty Member, Department of Family Medicine
University of Ottawa

Gabriella Coleman
Wolfe Chair in Scientific and Technological Literacy
Department of Art History & Communication Studies
McGill University

Alan G. Marshall
Robert O. Lawton Professor of Chemistry & Biochemistry
Chief Scientist, Ion Cyclotron Resonance Program
National High Magnetic Field Laboratory
Florida State University

April Colosimo, Associate Librarian, McGill University

Karen Harpp
Associate Professor, Colgate University

Carmen E. Rexach
Professor, Mt San Antonio College, Walnut, California
member, Infectious Diseases Society of America

Normand Voyer, Chemist, OCQ, FCIC
Professor of Bioorganic Chemistry
Laval University
Director of PROTEO

David Zlotnick MDCM
Director Tarem
Jerusalem, Israel

Lisa Zlotnick MDCM
Jerusalem, Israel

Kevin M. Folta
Professor and Chair, Horticultural Sciences Dept.
University of Florida

Dr. David King
Senior Lecturer | Evidence-based Practice
School of Medicine
The University of Queensland

Karine Auclair
Professor of Chemistry
McGill University

« Older Entries
Blog authors are solely responsible for the content of the blogs listed in the directory. Neither the content of these blogs, nor the links to other web sites, are screened, approved, reviewed or endorsed by McGill University. The text and other material on these blogs are the opinion of the specific author and are not statements of advice, opinion, or information of McGill.