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Naturally Trained, Medical Pains

tequilaThe Canadian Association of Naturopathic Doctors has recently produced several television ads featuring Naturopathic doctors sporting white lab coats and stethoscopes highlighting their apparent medical training. “True or false? Naturopathic doctors are medically trained. Of course we are. I’m a naturopathic doctor,” responds Dr. Jennifer Forgeron, as her name, along with the dubious title “ND” appear next to her on screen. Other commercials attempt to dispel the notion that Naturopathic Doctors aren’t regulated, as small text in the corner of the screen subtly notes that ND’s are currently only regulated in five provinces. The screen then fades to the slogan “Medically Trained. Naturally Focused. ™” Just like their medical training, the validity of these television spots should be seriously questioned.

While the Canadian College of Naturopathic Medicine (CCNM), one of the two accredited Naturopathic schools in Canada provides some refreshing clarity on the pre-requisite basic sciences courses, as well as medical science-based courses in the ND curriculum as far as the names of the courses go, there is a depressing drop off in information subsequently. For example, the CCNM course description for Embryology lists the following only, “Basic principles and mechanisms of human development from conception to shortly after birth are discussed. The normal development of each of the body’s systems is reviewed, and examples of how abnormal development may occur are given.” No suggested texts are offered, or qualifications of the professors are included. Compounding the concern, it is immediately striking to see that courses such as “Homeopathic Medicine I” and “Massage/Hydrotherapy” are taught alongside these more legitimate courses.

Perhaps as confusing as the slogan CAND has adopted, is the near-ubiquitous association Naturopaths have with the stethoscope. If there was one instrument that isn’t more intimately tied to a doctor, I am not aware of it. A survey of the CCNM course list shows courses such as “Physical and Clinical Diagnosis Practicum I” which offers “competence in taking a patient history and performing a physical examination efficiently and accurately…the skills necessary to conduct a thorough systems-based physical examination, interpret physical findings, elicit a complete medical history, and document the information appropriately.” This would imply training in the use of a stethoscope under the supervision of a Naturopath preceptor, which raises the concern on whether students are being taught to use the device correctly, and more importantly, what conditions are being taught to diagnose. It is difficult to make a sweeping statement about a Naturopath’s proficiency with a stethoscope, but one thing is certain – they are not cardiologists.

The ultimate demonstration of proficiency however, is successfully passing an accreditation exam. One would suspect that in order to boast about being “medically trained,” an aspiring ND should have to complete the same medical licensing exams as a Medical Doctor. This is not the case – not by a long shot. The Naturopathic Physicians Licensing Examinations (NPLEX), while similar in structure to the American USMLE and Canadian LMCC exams are fundamentally different exams. The NPLEX is consistently shorter than the LMCC and USMLE in terms of questions asked and time allotted to write, notwithstanding that it has the additional burden to testing Naturopathic in addition to the Medical content. I wonder how Naturopaths would fare writing the USMLE…

Most concerning about these videos is the underlying message that a Naturopath is sufficient on their own to treat a health issue. The saddening events surrounding the death of Ezekiel Stephan from meningitis after being misdiagnosed and treated with echinacea instead of antibiotics by a Naturopathic doctor is a reminder of the harm those claiming to have a medical training can do. Meningitis is a diagnosis that fundamentally cannot be missed, and one that is taught to medical students early on and repeatedly throughout their training.

Allopathic, or medically-trained doctors are certainly not immaculate when put under the spotlight either. It would be foolish to not suggest that some MD’s have abused their training in similar ways to ND’s, or failed to treat serious medical issues to a reasonable standard. The separation lies with the fact that medicine is a science that subjects itself to the dominion of evidence over all else. What can be proved to not be effective is discarded from the arsenal of medical science, a concept quite the contrary to naturopathy, which makes a nest from the discarded scraps of evidence-based medicine, and then calls it “alternative.”

No doubt, these videos by the Canadian Association of Naturopathic Doctors have been produced reflexively to the increasing public and media attention they have received after cases like Ezekiel Stephan. They insidiously mask that beneath the stethoscope-wielding, white-coated pseudophysician lies an organization in turmoil, struggling to increase their legitimacy and breadth of care, paying little attention to the training they provide and even less to the impact they will have.

One has to wonder then, when a Naturopathic doctor asserts to you that they are medically trained, will they point to a poster in their office, written in small hardly visible text, listing the terms and conditions?

Jason Gencher

Lyrics that convey scientific truths

Screen Shot 2016-11-04 at 5.59.56 PMMary Poppins, starring Julie Andrews, was a big hit for Disney studios in 1964. The film was a musicalized version of the children’s books about a magical English nanny written between 1934 and 1988 by P.L. Travers. The movie featured a number of songs written by Robert and Richard Sherman including the catchy tune sung by Andrews with the line, “A spoonful of sugar helps the medicine go down.”

The idea for the lyrics came from a real life situation. Robert Sherman was working on ideas for a song but was drawing a blank until one day he came home and learned from his wife that his children had received a polio vaccine. Thinking that the vaccine had been a shot in the arm, he asked one of his children whether it had hurt. Not at all, the child replied. There had been no jab. A drop of liquid was placed on a sugar cube that had to be swallowed. At that moment the title for the song was born!

The oral vaccine that the Sherman children received had been developed by Albert Sabin and was introduced commercially in 1961. It used a weakened form of the polio virus that triggered the production of antibodies against the active virus. The oral version to a large extent replaced the original injectable vaccine introduced in 1955 by Jonas Salk based on an inactivated form of the virus. Thanks to these vaccines, polio has been largely eliminated from the world.

Of course, every sort of medical intervention is associated with some risk. In very rare cases, the vaccine can cause polio symptoms, but the benefits greatly outweigh any risk. Both vaccines are on the World Health Organization’s Model Lists of Essential Medicines, the most important medications needed in a basic health system. Had the vaccine been available earlier, U.S. president Franklin Roosevelt would not have contracted polio in 1921.

The spoonful of sugar in combination with a medicine may have an impact other than just pleasing our musical appetite. It seems that infants given a little bit of a sugar solution feel less pain during injections. British pediatrician Paul Heaton found that a few drops of sucrose solution put on their tongues before an injection was capable of blocking the pain felt in their arms or bottoms. He theorizes that: “The sweet taste works through nerve channels in the tongue that perceive sweetness in the brain.” The brain reacts by producing endorphins, the body’s natural pain relievers. Furthermore, in babies, sucking releases endocannabinoids that also alleviate pain. Heaton noted that once babies taste the solution, they cried less and recovered more quickly from the jab. He recommends giving babies just enough sugary solution to taste, but not enough to swallow before vaccination. Interestingly, the relationship between sweets and pain relief was first mentioned in historic Jewish texts that document baby boys being given honey before circumcision. What about adults? Well, chocolates, sweet pastries and soft drinks make for a less painful life for many people.

The Sherman brothers also composed the song that has been played more often in the world than any other. It’s a Small World After All is featured at all the Disney theme parks, an adaptation of an attraction introduced at the New York World’s Fair in 1964. The Sherman Brothers wrote the song in the wake of the 1962 Cuban Missile Crisis, which influenced the song’s message of peace and brotherhood. They also wrote a song for the Adventure Thru Inner Space attraction that was presented in Disneyland’s Tomorrowland from 1967 to 1985 designed to simulate humans shrinking to a size smaller than an atom. Visitors boarded Atommobiles and began a journey that passed through snowflakes into the inner space of molecules, then atoms. They got an idea of crystal structure, bonding between atoms and the composition of an atom. The journey was accompanied by the song Miracles from Molecules.

From the beginning until 1977, Adventure Thru Inner Space was sponsored by the Monsanto Company, which later transitioned from being a chemical manufacturer to a biotechnology firm. Founded in 1901 by John Francis Queeny and named after his wife’s family, Monsanto initially produced food additives like saccharin and vanillin before expanding into industrial chemicals such as sulphuric acid and PCBs in the 1920s. By the 1940s, it was a major producer of plastics, including polystyrene, as well as a variety of synthetic fibres. Monsanto scientists had a number of notable achievements, like the development of “catalytic asymmetric hydrogenation,” that made possible the production of L-Dopa, the major drug used in the treatment of Parkinson’s disease. They also laid the foundation for the mass production of the light emitting diodes (LEDs) that have revolutionized the lighting industry.

Monsanto has been criticized for once manufacturing such controversial products as the insecticide DDTPCBs used as insulators in electronic equipment and the notorious Agent Orange that was widely deployed as a defoliant during the Vietnam War. At the time, DDT and PCBs solved immediate problems, with DDT saving millions of people from contracting malaria and PCBs in transformers making electricity widely available. The environmental issues that eventually emerged concerning these chemicals were not, and probably could not have been foreseen at the time.

Today, most people associate Monsanto with genetic modification and the company serves as a lightning rod for anti-GMO activists. Indeed Monsanto was among the first to genetically modify a plant cell and one of the first to conduct field trials of genetically modified crops and now markets canola, soy, corn and sugar beet seeds that yield plants capable of resisting herbicides and warding off insects.

Let me end with a stanza from the Sherman brothers’ song Miracles from Molecules that once captivated visitors to Disneyland and which I believe is still meaningful today:

Now Men with dreams are furthering,
What Nature first began,
Making modern miracles,
From molecules, for Man

 

Dr. Joe Schwarcz

You Asked: How can homeopathic teething “remedies” that essentially contain nothing have an adverse effect on infants?

question markThe FDA in the U.S has raised alarm about homeopathic teething pills that may have caused seizures in babies and possibly even caused some deaths. But how can homeopathic “remedies” do this, given that they contain nothing? The bizarre tenet of homeopathy is that a substance that causes symptoms in a health person can relieve those symptoms in a sick person as long as it is diluted to an extent that contains almost zero or a just a trace amount of the original substance. Homeopathic teething remedies are made by diluting a solution of belladonna in an extreme fashion.

Why belladonna is the preferred substance is bizarre since according to homeopathic doctrine, to relieve pain, it should cause pain when used at a high concentration. While atropine, the active ingredient in belladonna can cause many adverse symptoms, it doesn’t cause pain. In any case, when diluted homeopathically, it should have no effect.

Now it seems some homeopathic companies are not very adept at making dilutions and the effects on the babies were likely caused by an overdose of belladonna. Dilution is really a very simple process, so it is hard to see how they could get it so wrong. It seems homeopaths are not only incompetent when it comes to understanding chemistry and medicine, some are also incompetent at carrying out dilutions. Obviously homeopathy is not always just benign nonsense.

Joe Schwarcz PhD

Alkaline Nonsense

DNAIt is so seductively simple.  If you want to avoid cancer, just make sure your body is “alkaline!”  Here is the rationale.  When a cell becomes cancerous it reduces its use of oxygen and cranks up its production of acids.  These conditions then allow such cells to multiply quickly.  To counter this, you have to ensure that cells get an adequate supply of oxygen and that the acids produced are neutralized.  How?  By introducing sources of oxygen such as hydrogen peroxide or ozone into the body and consuming “alkaline” foods.  If cancer has already taken a foothold, then it may be necessary to dose up on cesium, the “most alkaline nutritional mineral.”  So simple, and so wrong!

As so often happens, promoters of nonsensical therapies seize a few filaments of scientific fact and weave these into a tangled web that ensnares the desperate and the scientifically confused.  In this case, it all starts with the work of German physician Otto Warburg who received the 1931 Nobel Prize in medicine for his work on cellular metabolism.  Warburg showed that that the growth of malignant cells requires markedly smaller amounts of oxygen than that of normal cells and that their metabolism follows an “anaerobic” pathway leading to the production of lactic acid.  This notion lay dormant until the 1980’s when Dr. Keith Brewer, a physicist with no medical training, used it to support his perplexing theory of how potassium and calcium control the transport of glucose and oxygen into cells, and how irritation of the cell’s membrane interferes with this transport system.  The result, Brewer maintained, is the “Warburg effect,” which lowers the cell’s pH, reduces its oxygen supply, and causes changes in DNA characteristic of cancer.  He then went on to claim that cesium’s chemically similarity to potassium allows it to be readily taken up by cells, but that unlike potassium, it does not transport glucose into cells while allowing oxygen to enter.  As a result, cancer cells are enriched in oxygen, deprived of glucose, form less lactic acid, become more alkaline, and as a consequence, die.  Sounds good, but Brewer got the “Warburg effect” all wrong.  Cancer cells do shift to a mode of metabolism that doesn’t use oxygen, but this happens even in the presence of oxygen!

Brewer went on to buttress his argument by claiming that cancer is almost unknown among the Hopi Indians of Arizona, the highland Indians of Peru and the Hunza of North Pakistan.  Why?  Because due to the cesium in the soil, they have a “high pH” diet.  Whether these people actually do have a lower cancer rate is questionable, and even if this were the case, it could not be ascribed to cesium in the diet without further investigation.  But then to take the cake (undoubtedly cesium enriched) Brewer in 1984 published a paper with the following claim: “Tests have been carried out on over 30 humans and in each case the tumour masses disappeared.  Also, all pains and effects associated with cancer disappeared within 12 to 36 hours; the more chemotherapy and morphine the patient had taken, the longer the withdrawal period.”  Not only had he discovered the cancer cure that had eluded the thousands of PhDs and MDs working in cancer research around the world, but he also showed that chemotherapy was actually harmful.  Quite a claim!

And just where were these miraculously cured patients, and who had treated them?  Brewer refers to Dr. Hellfried Sartori (aka Prof. Abdul-Haqq Sartori) who had accomplished this incredible feat in the Washington D.C. area.  This is the same Dr. Sartori who in July of 2006 was arrested in Thailand for fraud and practicing medicine without a license.  He was charging desperate patients were up $50,000 for “cancer cures” which included cesium chloride injections.  The good doctor, who routinely promised that he could cure his patients of any disease, has a rather illustrious history.  Known as the notorious “Dr. Ozone” in the U.S. , he served five years in prison in Virginia and nine months in New York for defrauding patients with unapproved therapies such as cesium chloride injections, coffee enemas and ozone flushes.  Needless to say, there are no records of the patients whom, according to Brewer, Sartori cured of cancer.  Australian police are now looking into the deaths of six people who died after intravenous injections of cesium chloride at clinics following Sartori’s protocol.

Introducing ozone or hydrogen peroxide to raise cellular oxygen levels is a scientifically bankrupt idea, as is raising a cell’s pH with cesium chloride.  Of course, it is not the absurdity of the theory that rules out its effectiveness, it is the lack of evidence!  There are no controlled trials showing cancer being cured with ozone or cesium.  But there is evidence that cesium chloride can cause cardiac arrhythmia and death.  Granted, it is unlikely that this can happen from the oral doses being promoted by numerous alternative practitioners aimed at raising the body’s pH, but the idea that cesium chloride can neutralize acids in cells is sheer nonsense.

Yes, cesium is an “alkali” metal.  Dropping a piece of cesium metal into water does indeed produce an alkaline solution (and an explosion).  But cesium chloride is not the same as cesium metal, it is a neutral salt.  In any case, the blood’s pH cannot be altered by cesium chloride ingestion, or indeed with the ingestion of any food.  It is a marvelously buffered system, meaning that it resists any change in acidity.  It doesn’t matter what we eat or drink, our blood contains substances that can act as acids or bases to maintain our blood pH at 7.4.  The only body fluid that responds to diet in terms of pH is the urine.  Breads, cereals, eggs, fish, meat and poultry can make the urine more acidic while most, but not all, fruits and vegetables make the urine more alkaline.  A diet high in fruits and vegetables and low in meat can indeed reduce the risk of cancer, but this has absolutely nothing to do with changing the pH of cancer cells.  The idea of an “alkaline” diet to prevent or treat cancer may sound seductively simple, but in reality it is just simple minded.

Joe Schwarcz PhD

The U.S. Toxic Substances Control Act (TSCA)

dangerAmidst the cacophony of jingoist, vacuous blather at the Republican Convention there were some noteworthy phrases that probably slipped by most viewers. A number of speakers talked about the need to reign in the activities of the Environmental Protection Agency, the “EPA.” That is something one would expect from Republicans who want as little government interference in their life as possible. But these are the same Republicans who voted to update the 1976 Toxic Substances Control Act that finally was passed in June by Congress with bipartisan approval after ten years of debate. This update was very much needed because significant information has been accumulated since 1976 about exposure to chemicals in the environment and their potential effect on health.

The old law required companies to register new chemicals that would enter commerce with the EPA but there was no requirement to furnish any safety data, and there was no provision for EPA to tackle the risks associated with chemicals already on the market at the time. The assumption was that chemicals are safe unless shown to be otherwise. The EPA did have the power to ban a chemical, but the burden of proof of harm was on the agency. Also, the economic downsides had to be factored in before the use of any chemical was limited. With companies introducing about 700 chemicals every year, and the EPA inventory building up to some 85,000 substances, the task of ferreting out dangerous ones is overwhelming. While determining risk when exposure is high, such as in an occupational setting, is relatively easy, determining risk to consumers who may be exposed to some chemical in tiny amounts over a long period is daunting.

But under the new law, EPA has to examine a chemical before it is put on the market and make a decision about safety. The risk assessment will take into account how a chemical is used. For example, a fluorinated compound may be deemed to be fine for use in airplane fire extinguishers, but not as an oil repellant in pizza boxes. An important new feature is that the agency will now have the authority to ask for information from producers about studies that have been carried out and can even ask for further studies. Another new facet is that EPA does not have to consider the economic implications of declaring a substance to be toxic. Furthermore, it is going to be much tougher for a company to withhold information claiming trade secrecy.

There are also 90 chemicals that have been identified as meriting investigation and possible regulation with EPA having to adhere to mandatory deadlines. The new bill has the support of the chemical industry because it should reduce consumer angst given that EPA will now be charged with examining the safety of chemicals before they go on the market. But here is the issue. While Republicans in the House voted for the bill, they also voted to cut the EPA’s funding and staffing for 2017. If EPA is going to carry out its new duties effectively, it will need more, not less funding. The plan is that some of the shortfall will be offset by charging companies fees for submitting chemicals for EPA to review. That may not sit well with Republicans.

Joe Schwarcz PhD

Cats and catnip

catWhat do we know about cats? You show them a litter box and they will from that moment on never make anywhere else in the house. Try that with a dog. Cats don’t have receptors for sweets, so you can’t train them by offering them sweet treats. In fact, you can’t train  them at all. That’s supposedly because they are too smart to cater to human whims. I don’t know about that; after all, they will chase the beam of a laser pointer ad nauseum, never learning that they cannot catch it.

If you think your cat is affectionate towards you because he or she rubs up against your leg, think again. They are just marking you as their territory, so that if they find themselves in danger, they’ll know where to run for protection. Cats do have a remarkable ability to land on all fours if you toss them into the air, and they are pretty good at catching mice and birds that they will then offer as a present to the household where they happen to be living. If you want to reciprocate to this kindness, you can offer them a little catnip. They’ll immediately turn on their back and wait for some tummy rubbing. Why they respond to the scent of this flowering plant is a mystery since it doesn’t seem to offer any evolutionary advantage. Actually, not all cats are attracted, but roughly three quarters of them are. Some sort of genetic trait is likely involved. Furthermore, only mature cats are attracted, kittens are actually repelled by the scent.

The chemical in the scent of catnip that produces cat euphoria is nepetalactone. The plant does not produce this compound to attract cats. Since cats do not pollinate, and do not eat insects, there is no advantage to the catnip plant to attract felines. So we have to look elsewhere for any advantage offered to the plant by nepetalactone. It turns out that this compound happens to be a pheromone, or sex attractant, for aphids, the tiny sap-sucking insects that can sap the life out of a plant.

Obviously there is no advantage to the plant in attracting aphids. But there is an advantage in attracting aphid predators. The lacewing fly and creepy wasp find that aphids provide just the right environment for laying their eggs and have learned to hunt down aphids by going after the pheromone they produce. The catnip plant takes advantage of this phenomenon and churns out nepetalactone to attract the aphid predators that then lay their eggs inside the live aphids and end up killing them.

While cats love catnip, cockroaches do not. The scent of nepetalactone sends them skittering away.  Removing the roaches’ antennae renders them indifferent to nepetalactone, revealing that it is receptors on these rather than on the feet or in the mouth that respond. Nepetalactone also repels a variety of biting insects, including the mosquito. But it’s not a good idea to use an insect repellant based on this chemical if you are on safari. Catnip attracts big cats too. Like lions, tigers and leopards. I don’t think you want these guys rubbing against your leg.

Joe Schwarcz PhD

Small beads can make for a large problem

dangerScience can make for a strange bedfellow. I had just finished recording a video showing off one of my favourite sweaters and expounding on the ingenuity and the environmental benefit of it being made from recycled polyester bottles when an article appeared on one of my newsfeeds about how “your clothes are poisoning our oceans and food supply.” The message was that the very fabric I was so high on may be unravelling the fabric of society.

I must say I was puzzled by the headline, but on glancing through the story, the details of the problem quickly came out in the wash, as it were. Synthetic fabrics are not exactly inert and release microscopic bits of fiber when washed. The particles may be microscopic, but their number is anything but. Researchers at the University of California found that a synthetic fleece jacket releases hundreds of thousands of microscopic fibers, about 2 grams in total, with each wash. Wastewater treatment removes some of this debris, but most of it ends up in rivers, lakes and oceans where it can be consumed by wildlife. The fibers then can bioaccumulate up the aquatic food chain, right up to people consuming fish. Whether this presents a risk is not known, but bits of plastic are not a desirable dietary component. The clothing industry is sensitive to the problem and is working on coatings for fabric that would reduce shedding. Also in the works are washing machines that prevent the release of microfibers by using pressurized carbon dioxide instead of water.

The shedding of microfibers from synthetic fabrics is not the only way tiny pieces of plastic, invisible to the naked eye, end up in water systems.” Microbeads,” introduced into consumer products such as toothpaste and exfoliating skin products as abrasives, are a bigger concern. Six varieties of the tiny beads are used. Those composed of either polyethylene, polypropylene or expanded polystyrene are more likely to float, whereas the ones made of polyvinyl chloride, nylon or polyethylene terephthalate (PET) are more likely to sink. McGill biologist Anthony Ricciardi has found microbeads in significant numbers in sediment at the bottom of the St. Lawrence River, meaning possible contamination of fish that feed on the riverbed.

Microbeads range in size from 10 millionths of a meter to one millimeter. Their round shape makes them much less irritating than irregularly shaped, abrasive exfoliants like apricot kernels or walnut shells that have sharp edges. Also, because the particles are tiny spheres, they act as little ball bearings, allowing for easy spreadability of creams and lotions as well as a smooth texture and silky feel. There’s more. Imperfections in the skin tend to be visible because of the contrast between how they reflect light compared with the surrounding tissue. Microbeads with their ability to scatter and diffuse light can minimize the appearance of fine lines and improve skin tone. When it comes to toothpaste, though, they make a minimal contribution to polishing the teeth and may actually become embedded in gum tissue. Why are they there? Since the microbeads can be produced in various colours they can also increase the visual appeal of a product.

A single container of face wash can contain hundreds of thousands of the microspheres. While the virtually indestructible plastic beads are not themselves toxic, once they enter the water, they attract potentially toxic substances such as PCBs, triclosan and nonylphenols. Like the microfibers, microbeads can then become part of the aquatic food chain, eaten by fish and then by people. Once consumed, the beads may also leach out plastic additives like colourants, plasticizers and ultraviolet light stabilizers.

Researchers have found fish both in the oceans and the Great Lakes contaminated with microbeads. Besides carrying toxins, the beads can cause internal abrasions and can stunt growth of the fish by giving them a false sense of being full. One-third of fish caught off the south-west coast of England have been found to contain microbeads and  Belgian researchers studying seafood from German farms and French supermarkets found that an average portion of mussels can contain about ninety microplastic particles, and an order of oysters about fifty. The beads have also been found to lodge in the guts of crabs as well as in their gills.

The number of microbeads that end up in the environment is staggering. In New York State alone some 19 tons go down the drain every year. Most wastewater plants are not equipped to filter out such fine particles and while they could be retrofitted, the expense would be prohibitive. Drinking water poses less of a problem because municipal water treatment plants can filter out the tiny particles although a sampling of German beers found microbeads in every bottle, with the water used being the likely source. Both Canada and the U.S. have moved to ban microbeads and manufacturers have started the process of phasing them out. Researchers agree that there are still too many unknowns to fully assess the environmental damage caused by microplastics but given that they do not contribute significant benefits they should be eliminated.

But the problem of plastic waste in the oceans is greater than can be accounted for by microfibers and microbeads. Other tiny particles form from the breakdown of plastic bags, bottles and all sorts of containers that get discarded end up in waste streams that empty into the ocean. “Biodegradable” on a label means that the plastic has been shown to degrade under ideal composting conditions, but these do not exist in the natural environment. Estimates are that the ratio of plastics to fish by weight in the oceans is 1:5 and with our current callous attitude towards “reduce, recycle, reuse,” it is set to increase to 1:1 by 2050.

Given these concerns, I don’t think I can wear my “made from a plastic bottle” sweater with the same pride as before. And I may even feel a bit of apprehension tossing it into the laundry basket.

 

Joe Schwarcz

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

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