Vol. 22, No. 1
and Notices from Other Societies and Unions
The Morbidity and
Mortality of Scientific Illiteracy
This article, by Prof. Donald Weaver,
is reprinted with permission from Canadian Chemical News, Vol.
51, No. 7, pp. 5ñ6 (July/August 1999). Prof. Weaver is a Fellow
of the Canadian Institute of Chemists (FCIC) and a professor in both
the departments of chemistry and medicine at Quee's University in Kingston,
Ontario, Canada. He was the winner of the Merck Frosst Centre for Therapeutic
Research Lecture Award in 1997 and is currently the director representing
the Biological/Medicinal Division on The Canadian Society for Chemistry
(CSC) Board of Directors.
Chemistry is the central science, drawing on the basic
principles of physics while enabling biological phenomena to be understood
at a molecular level. From this unique position, chemistry pervades
virtually every aspect of modern life, influencing the quality of the
water that sustains our lives, the pharmaceuticals that save our lives,
and the advanced materials that enrich our lives. It would seem reasonable
that a truly informed person in the modern world should have at least
a rudimentary scientific literacy in the molecular sciences (as well
as being able to read and write). Regrettably, this is not the case.
Scientific illiteracy, scientific innumeracy, and the growth of pseudoscience
("junk science") are the reality. The ramifications of these failings
could be disturbingly significant.
Nowhere are the implications of these failings more apparent
than in the health care system. Modern society expects a pill for every
ill, a molecule for every ailment-and it had better be a molecule with
optimal efficacy and minimal toxicity. The obvious, but underappreciated,
fact is that drugs and medical treatments are based on molecules. Not
surprisingly, the development of medical therapeutics is dependent more
on chemistry than on any other scientific discipline. Drugs exert their
effects via a receptor, a macromolecule that is crucial to the pathogenesis
of the disease under study. A first step in the rational drug design
process is the resolution of the three-dimensional structure of this
receptor by a structural chemist, such as an X-ray crystallographer.
Next, the medicinal chemists and organic chemists design and synthesize
drug molecules to bind with the receptor. Computational chemists and
molecular modelers facilitate this drug design process. Analytical chemists
aid in determining the drug's pharmacokinetic half-life and metabolic
properties. Finally, process chemists and chemical engineers work out
methods for scale-up and quality control. This sequence of events is
poorly appreciated in the general population for whom the realization
that "physicians don"t discover drugs, chemists do is a startling revelation.
The failure to appreciate chemistry and the molecular
sciences is apparent on an everyday basis in medical practice. In my
own medical practice, the following five cases occurred during a recent
The first was a patient who refused to receive intravenous
antimigraine drugs because she was concerned that the sodium chloride
and glucose in the intravenous solutions were synthetic in origin. She
passionately believed that the molecules and even the constituent atoms
themselves were fundamentally different between synthetic glucose and
natural source glucose. For the safety of her own health, she "did not
want to be exposed to synthetic atoms and molecules.
The second was a patient who abruptly stopped his antiseizure
medications. He did so after purchasing two rather large horseshoe magnets
which he now places on either side of his head when he sleeps at night.
He informed me that the magnetic field promotes the electrons of his
brain molecules into higher energy levels, thus permitting "truly natural
healing to take place. In fact, he was disturbed that I was unaware
of such basic scientific principles as applied to issues of human health
care. Because he had suddenly stopped his anticonvulsant drugs, he experienced
several severe seizures producing a painful recurrent shoulder dislocation.
The third was a patient who stopped taking her cholinesterase
enzyme inhibitor for Alzheimer's disease. At her family's urging, she
was taking large doses of Vitamin E and Gingko biloba at four
times the recommended daily dose, because "everyone knows that natural
products are safer. The family refused to believe that their mother's
recent hemorrhages were due to this mixture of agents-"vitamins and
natural products are inherently safe and quite harmless.
The fourth is a patient who suddenly stopped his anticonvulsant
drugs and began to consume massive doses of vitamin B6 to cure his epilepsy.
He had learned of this supposed cure from an Internet chat group. He
soon developed severe numbness in his hands and feet from vitamin B6
toxicity, but refused to believe that a natural product could produce
such side effects. Moreover, since he had precipitously stopped his
anticonvulsant drugs, he experienced multiple seizures, resulting in
the loss of his driver's license and ultimately his job.
The fifth is an epileptic patient who decided to forego
her conventional therapy in order to have "the bone plates in her skull
manipulated. She had read that the skull is composed of bones that fuse
as a young child. She had been told that incorrect fusion of these bones
"impedes the harmonious flow of chemicals over the surface of her brain,
thus causing seizures. She now visits an alternative medicine practitioner
who literally beats up her head once a month, supposedly to realign
this claimed aberrant bone fusion. She stopped taking her anticonvulsants
and has recently experienced a recurrence of her seizures. Not surprisingly,
she now also has headaches.
These five people are not educationally deprived-all have
high school education, and two have post-secondary school education.
They are simply average Canadians trying to do what they think is best
The problem of scientific ignorance on the part of patients
and their families is by no means restricted to patients with neurological
problems. It is an issue that is becoming increasingly widespread. A
recent high-profile court case reported from Hull, Quèbec further
attests to this problem. A Quèbec naturotherapist has been convicted
of criminal negligence causing death after telling the family of a diabetic
girl to substitute baths and herbal remedies for her insulin shots.
The 12-year-old girl died from complications of her diabetes on 28 March
1994. She died for want of insulin in Canada, the homeland of Banting
The situation is probably only going to get worse. Medical
therapeutics are getting more complicated. With the new millennium will
come improved receptor site-specific drugs, gene therapies, anti-apoptotic
agents, and a variety of other increasingly sophisticated chemical attacks
on human disease. Members of the general public are increasingly less
equipped to deal with such issues. This situation calls into question
that sacred concept called "informed consent. As every physician knows
(and as every lawyer is quick to remind us), it is the obligation of
the physician to ensure that patients understand their therapies. Where
does one start? Is it truly possible to obtain informed consent from
an individual who genuinely believes that having her head systematically
punched once a month to reshape skull morphology will beneficially influence
neurotransmitter flow in the superficial layers of the cerebral cortex?
Furthermore, with medical schools deleting chemistry as a prerequisite
(to pursue "more human-centered disciplines), the physicians themselves
won"t understand the newly evolving molecular-based therapies. It will
ultimately be a situation with the blind leading the blind.
Concomitant with this rise in scientific illiteracy has
been the blossoming of so-called alternative therapies. Yes, the snake
oil salesman is back! Most alternative therapies are well intentioned,
some may work, and a number are probably fraudulent. Alternative therapies
come in a wide variety, including the good, the bad, and the downright
ridiculous. First, there is the megavitamin approach. This regimen is
based upon the notion that if a little of something is good for you,
then a whole lot is probably really good for you. Apart from producing
expensive and usually brightly colored urine, there are little, if any
hard data to support the widespread use of large doses of vitamins.
Next are the dietary approaches. There are the high-protein/low-carbohydrate,
high-carbohydrate/low-protein, high-protein, and no-protein diets-all
with the exact same therapeutic objective. These diets are sometimes
coadministered with high colonic enemas and irrigations "to purge the
body of its toxic chemicals. Once again, there is no scientific evidence
to suggest that bowel toxins contribute significantly to the plethora
of human suffering. Finally, there are the therapeutic touch practitioners.
Therapeutic touch involves practitioners systematically waving their
hands over the affected individual. This practice supposedly promotes
therapeutic perturbations in the conventionally undetectable human energy
fields surrounding the patient.
Of all the alternative therapies, the most rapidly growing
is the use of herbal remedies. In 1997, North Americans spent an estimated
$12 billion for herbal and mineral products. Between 1993 and 1998,
this market grew by 30-50 percent. Within this same time frame, the
U.S. Food and Drug Administration received 2 621 reports of serious
health effects-including 101 mortalities-linked to supplements. A small
number of supplements dominate in the market. DHEA is a hormone reported
to boost energy levels, augment muscle healing, and slow aging - it
certainly received glowing recommendations from Mark McGwire. However,
when it comes to toxicity DHEA doesn't hit the ball out of the park;
it may increase the risk of breast and prostate cancer. Another agent
with mixed effects is ephedra. Although ephedra (ma huang) has been
purported to control weight while it reinvigorates, its use has been
linked to high blood pressure, headaches, seizures, and even death.
Like ephedra, yohimbe has also been put forth as an agent to reinvigorate
and even to augment male sexuality; however, it possibly produces weakness,
paralysis, or death. Echinacea is widely used in the prevention and
treatment of viral upper respiratory tract infections. Although several
trials have suggested that the herb might reduce cold symptoms, long-term
use may paradoxically produce immune-system suppression. A 1997 U.S.
study suggested that Ginkgo biloba may symptomatically improve
mental performance in patients with mild to moderate dementia. Nevertheless,
its use is sometimes complicated by bleeding problems, gastrointestinal
disturbances, and headache. Finally, there is saw palmetto. Preliminary
work suggests that saw palmetto shows promise for benign enlarged prostate
disease; however, it too has its Achilles" heel, causing stomach upset,
headache, and even erectile dysfunction.
The problem with alternative therapies like the herbals
is not with their potential therapeutic benefits. Herbal remedies do
contain an interesting mixture of flavone glycosides, terpene lactones,
and various phenolic derivatives. Most chemists would agree that Mother
Nature is a truly amazing synthetic chemist and that natural products
such as herbals do represent an opportunity for impressive molecular
diversity. In fact, the recent growth of combinatorial chemistry is
an attempt to reproduce this diversity generation in the laboratory
setting. Rather, the problem with alternative therapies is the failure
of society to hold them accountable to the same rigorous scientific
scrutiny used for conventional drugs. Just because they are natural,
doesn"t make them safer. After all, cobra venom comes from an all natural
source. The worsening of scientific illiteracy and scientific innumeracy,
combined with the flourishing growth of pseudoscience, is not helping
to ameliorate this situation.
In general, society places less value on the pursuit of
scientific rigor, and is increasingly less inclined to listen to its
mainstream scientists. When it comes to chemistry and the physical sciences,
people think of thalidomide, DDT, and plutonium bombs. They do not think
of penicillin, AZT, and Dacron aortic patches. A truly appalling event
occurred earlier this year in Washington, DC, when members of the Committee
on Government Reform listened raptly to actress Jane Seymour extol the
virtues of alternative medicine, such as homeopathic treatments for
cancer and acne. Dr. Quinn, Medicine Woman, was invited to present at
the inquiry because "actresses are role models who have tremendous effects
on public attitudes, and thus their opinions on science should be studied
("I'm not a doctor, but I play one on TV). On the other hand, when the
Nobel laureate Gertrude Elion recently died, her life did not make the
cover of Time Magazine or the national newscasts. Elion had been
involved in the discovery of drugs such as azathioprine, trimethoprim,
and acyclovir (to name only three of the many drugs to which she was
a central contributor). However, this hat trick of discoveries is not
enough to get her into the record books of the lay press. She did not
strive for personal fortune or fame. She didn"t set NHL, NBA, or box
office records. She just used good rigorous science to save many lives
and to help humankind.
In the next millennium, humankind will have to confront
an array of assaults. There is the specter of prion diseases, killer
viruses, drug-resistant bacteria, and environmental cancers-prospects
made even more scary by the decline of scientific literacy and the rise
of pseudoscience. It is not productive to stick our heads in the sand
while arrogantly decrying reductionism and the tenets of Western science.
These problems cannot be avoided; they will have to be confronted using
good rigorous science as a weapon of salvation-a weapon hopefully wielded
by people who know how!