AlteredNative

So much of what passes as "Alternative Medicine" is mere fuzzy thinking, based on anecdote and hope. But it sells --- it offers a quick fix, one that doesn't require hard work and years of study to understand.

But in real medicine, as in all fields of knowledge, a deep understanding of fundamental processes is the first step toward doing something useful. Case in point: a couple of paragraphs from an article on the history behind Viagra (in Modern Drug Discovery, Nov/Dec 1998, by Jim Kling --- see http://pubs.acs.org/hotartcl/mdd/98/novdec/viagra.html ). Jump straight into the deep end of the swimming pool and skim the following:

Rather than trying to administer ANP or an ANP mimetic, Campbell and Roberts proposed augmenting ANP activity with a drug that would manipulate the secondary intracellular signals that occur when ANP binds its receptor. ANP receptor binding activates guanylate cyclase, allowing it to convert guanosine triphosphate (GTP) to cyclic guanosine monophosphate (cGMP). The general cellular response to a buildup of cGMP levels is to reduce the amount of free intracellular calcium, either by flushing it from the cell or sequestering it within. The physiological consequence of decreased calcium depends on the location and function of the cell. In platelets, which cause blood clots, the result is platelet deactivation. In the kidney, the result is smooth muscle cell relaxation and release of sodium. Elsewhere, vascular muscles relax and allow blood vessels to fill with more blood, lowering overall blood pressure.

Levels of cGMP are held in balance by enzymes known as phosphodiesterases (PDEs), which convert cGMP into GMP by breaking the cGMP's cyclic phosphate ring. GMP is subsequently converted to GTP by another enzyme, completing a cycle: from GTP to cGMP, then GMP, and finally back to GTP. It was the PDEs that Terrett and his team decided to target for drug develpment, reasoning that a PDE inhibitor could prevent the breakdown of cGMP created in response to ANP. cGMP concentations would then increase, thanks to PDE inhibition, and if in response smooth muscle cells in the kidney and blood vessels did their part and relaxed, blood pressure would drop. And Pfizer might have a winner in the hypertension market.

Whew! Are your eyes glazed over yet? (Biochemists in the audience are excused.) I don't follow the acronym-jargon either --- but the guts of what the above excerpt describes is much more general, and important. It's a beautiful, intricate clockwork mechanism with springs and balance-wheels and gears and regulators ... or in the steam-engine metaphor world, a contraption with valves and flywheels and governors and pressure gauges and reservoirs.

This is a system, in other words, with positive and negative feedback loops. It maps into a mathematical set of coupled differential equations. And that means that the situation can be understood, predicted, and controlled. We've got ~400 years of experience with this kind of thing. It's comfortable, like a familiar path through the forest or a well-worn pair of shoes. (for earlier comments on "systems thinking" see TransientBehavior, 11 May 1999, and FifthDisciplinarians, 10 Sep 2000)

The cGMP --> GMP --> CTP --> GTP cycle is one piece of a gigantic multidimensional jigsaw puzzle. It fits, almost perfectly, with thousands of other quantitative chunks of knowledge. Together these puzzle pieces form an amazingly resilient network, a coherent theory. The data --- accumulated by hosts of careful researchers, critiqued by their expert colleagues, and published in selective journals --- hang together. (see WebsOfEvidence, 15 Feb 2000)

Contrast this, to be blunt, with the quality of evidence for most "Alternative Medicine" hypotheses. (I won't name names here, to protect the not-so-innocent and to avoid hurting too many feelings among True Believers.) It's the difference between a child's sand castle and a gothic fortress, between a lightning bug and a lightning bolt.

Sure, most real-world day-to-day physicians --- overworked, overspecialized, overwhelmed --- don't have a vision of anything like the matrix of biochemistry and clinical medical knowledge. Most patients don't have a single well-defined problem; they display a thicket of conflicting symptoms. And then Money pushes it way into the halls of Science, in the persona of bottom-line-driven pharmaceutical companies, for-profit health care providers, and hungry professors who bend their principles to get grants.

It's not perfect; nothing human is. But it's a lot better than the Alternative....

(See also KnowHowAndFearNot, 19 Nov 1999, or ScienceAndPseudoscience, 6 Oct 2001)

TopicScience - Datetag20020124

The pure science of medicine is often removed from the actual practice of medicine. I wonder if the researchers involved in pure science would be comfortable with the course of treatment doled out to the average patient walking through the doctor's door. For instance, I read long and hard on ear infections. This is a big problem with little kids and my data, collected from hundreds of visits to local doctors on children of women in LLL (La Leche League)suggests that close to 100% of ear infections in young children (I collected this data more than ten years ago, and I hope this has changed) are treated with antibiotics, yet, according to the data that I have read in medical journals, close to 98% of ear infections which are cultured in young children are not bacterial. A high percentage are yeast inflammations which are aggravated if not caused by antibiotic therapy. Another piece of information that threw me is, again, related to LLL and young children; when electron microscopes were used to study the makeup of breast milk, huge numbers, I don't have the printed data anymore, of additional elements were found that had never been included in formula, although most medical doctors were and are completely comfortable encouraging women to give up breast feeding in favor of the inferior product.

What is the outcome of inferior infant food fed to an entire generation of adults? Cancer? Heart disease? Chronic high blood pressure? Who knows? I wonder if pure science has ever correlated a population of equals who were and were not breasted in childhood. I know that many of the best Japanese preschools will not accept a child who was not long term breastfed. (Again, information is ten years old.) That population might be interesting to study beyond what is already known...low incidence of breast cancer, prostate cancer, few problems with menopause. Much of what I read indicates that a diet high in soy is responsible for these better outcomes. Hmm.

Pure science is not available to the average consumer, perhaps because there is a breakdown in the information path between what is known in the lab and what is known in the doctor's office. The information that the doctor gets is often information given to him/her by the drug detailers, and again, follow the money. I hold suspect information from any source that is going to financially benefit.

Can science ever completely understand anything? What is known completely? I am a life long skeptic which is defined, "that absolute knowledge cannot be attained"...or saying, I could be wrong. Don't get me wrong, though, I applaud and deeply respect all who look and learn and study and utilize knowledge, and completely agree to beware of charlatans who promise what they cannot deliver. But, when it comes to medical care, don't use a cannon when a flyswatter will do the job. -- JudyDecker

(correlates: InFoamation, FifthDisciplinarians, TemporalUtilitarianism, ...)