Dr. Joe's Brain Sparks: 179 Inspiring and Enlightening Inquiries into the Science of Everyday Life - Softcover

DR. JOE SCHWARCZ is director of McGill University's Office of Science and Society, where he teaches courses on nutrition and the applications of chemistry to everyday life. Among his many honours are the Royal Society of Canada's McNeil Award, and the American Chemistry Society's renowned Grady-Stack Award, of which he is the only non-American recipient. Schwarcz is the host of a weekly radio show on CFRB in Toronto and CJAD in Montreal, and writes a weekly column for the Montreal Gazette.

CHEMISTRY: THE BEST MEDICINE
 
 
A drug introduced in 1981, isolated from a soil fungus, revolutionized the transplantation of human organs. What drug was that?
 
 
Cyclosporin. Early transplants were plagued by organ rejection. The recipient’s immune system considered the organ a foreign intruder and mobilized its forces for battle. Doctors realized that if transplants were ever to be successful, the body’s immune system would have to be held in check.
 
By the time Dr. Christiaan Barnard performed the world’s first heart transplant in 1967, drugs that curbed immune activity were available, but they left a lot to be desired. The medications managed to keep the immune system from rejecting the organ, but the extent of immune suppression was such that it left the patient susceptible to all sorts of infections. In fact, Louis Washkansky, the first recipient of a transplanted heart, died of pneumonia he contracted because of suppressed immunity. But the problem of rejection was essentially solved when cyclosporin came onto the scene in 1981.
 
The discovery of the first truly effective anti-rejection drug was somewhat serendipitous, and dates back to the early 1970s. In those days, pharmaceutical companies searched high and low for novel antibiotics, investigating whatever fungus they could get their hands on. After all, antibiotics isolated from fungi, such as penicillin and streptomycin, had already proven their worth. Hoping to find some novel antibiotic-producing fungus, pharmaceutical companies routinely asked their employees to bring back soil samples from their travels. The Sandoz company lucked out. A soil sample collected in Norway yielded a strain of fungus that produced a compound composed of a ring of amino acids, eventually named cyclosporine. It looked like a good candidate for antibiotic activity. Unfortunately, it turned out not to have any such properties.
 
Eventually, though, disappointment turned to elation when cyclosporine was found to have a marked immunosuppressive effect! Administering the drug presented a problem, however, since it was almost completely insoluble in water. When taken orally, it never made it into the bloodstream. But researchers discovered that dissolving the drug in olive oil did the trick. In 1978, the first kidney and bone marrow transplants in which cyclosporine successfully prevented rejection were performed in England. Today, hearts, kidneys, livers and bone marrow are routinely transplanted, thanks in large part to cyclosporine.
 
There is a footnote to the cyclosporine story, and a rather significant one. After a transplant, monitoring the use of all drugs taken by patients is critical because some medications can interfere with the action of cyclosporine. St. John’s wort, for example, an herbal remedy available without a prescription, can negate the effect of cyclosporine and result in rejection. This interaction came to light when a heart transplant patient’s body rejected the donated organ even though an appropriate amount of cyclosporine had been administered. Unknown to his physicians, he had been taking St. John’s wort purchased at a health food store to ward off his depression. He almost warded off his new heart.
 
 
 
Around 1000 BC, a Chinese monk introduced the idea of blowing a substance up the nose of people to protect them from smallpox. What was this substance?
 
 
A powder made from the scabs of pustules on the skin of people who had survived smallpox. The eradication of this horrific disease, which is thought to have first appeared around 10,000 bc, is one of the greatest triumphs of medicine. The last recorded case of smallpox occurred in Somalia in 1977, more than thirty years ago. How did this triumph come about? Simple: vaccination! The name associated with the introduction of the smallpox vaccine is Dr. Edward Jenner, an English country physician who acted on the observation that milkmaids who had come down with a disease known as cowpox never contracted smallpox. Jenner injected young James Phipps with material taken from a milkmaid’s cowpox pustule and then exposed him to smallpox. (Obviously, there were no ethics committees at the time to approve research.) The boy didn’t get the disease, and the era of vaccination, the term deriving from the Latin for cow, was on its way. Although Jenner usually gets the credit for introducing the smallpox vaccine, it was twenty years earlier that Benjamin Jesty, a farmer, inoculated his wife with the cowpox virus and showed that it protected her from the disease. Unfortunately, he didn’t have enough oomph to influence the medical community.
 
Even more amazing is that a technique known as variolation had been introduced by a Chinese monk almost two thousand years earlier. After the death of the son of a high-ranking Chinese official, the monk sought a way to cure the scourge of smallpox. He hit upon the idea of blowing the dust made from ground-up pustules taken from the skin of smallpox victims up the nose of healthy people. In all likelihood this was predicated on the observation that people who had survived smallpox became immune to the disease. Lady Wortley Montague learned of this technique when her husband had a political posting in Turkey. She brought it to the attention of the British royal family and suggested that variolation could be tested on condemned prisoners. Indeed, four such men were treated, and months later were exposed to smallpox. All four survived. This was enough to convince the royal family to undergo variolation. The French thought the English were crazy. In fact, Voltaire opined that “the English are fools, they give their children smallpox to prevent their catching it.” They weren’t fools. In smallpox survivors the virus becomes weakened and can offer protection to others, with only a small risk of causing the actual disease. The death rate from smallpox was usually somewhere between 20 per cent and 40 per cent, but the death rate from variolation was only about 1 per cent. It is interesting to note that this ancient technique saved many from contracting smallpox long before it was replaced by Jenner’s more effective vaccination.
 
 
 
“It may be that the world’s oldest medicine is the earth itself.” To what does that statement refer?
 
 
The ingestion of clay to absorb toxic substances. Terra sigillata, which literally means “earth that has been stamped with a seal,” was originally dug up each year only on August 6, on the Greek island of Lemnos. It was mixed with the blood of a sacrificial goat, shaped into lozenges and dried. The famous Greek physician Galen recommended it as an antidote to poisons way back in the second century ad. Kings and popes commonly ate terra sigillata with their meals. Clays really do have the ability to bind various substances, and they even exhibit a property known as “cation exchange.” This means they can absorb positively charged ions such as those of mercury and lead, which are highly toxic. Indeed, terra sigillata used to be an antidote to poisoning by mercuric chloride. A story from the sixteenth century speaks of a condemned German criminal who, in a bid to avoid execution, proposed an experiment to the court. He would act as a human guinea pig and take a potentially lethal amount of mercuric chloride, followed by terra sigillata in wine. If he survived, he would be released. Although he went through a torturous experience, the man did survive and was indeed freed! Today, refined clays, as in Kaopectate, are used to treat diarrhea caused by bacterial toxins in the gut. The clay can absorb the toxins and relieve the condition.
 
 
 
Both George Bush Sr. and his wife, Barbara, were diagnosed with Graves’ disease. This initiated the testing of the water in the White House for what substance?
 
 
Iodine. Graves’ disease is a form of hyperthyroidism, a condition in which the thyroid gland produces too much thyroid hormone. As a result, metabolism speeds up, leading to weight loss, insomnia, muscle weakness, tremors, sweating, frequent loose stools, palpitations, bulging eyes and a feeling of edginess. Thyroid hormone contains iodine, and it’s conceivable that too high an intake of iodine can cause it to be overproduced. But the usual cause of Graves’ is an autoimmune reaction in which antibodies in the blood stimulate the overproduction of thyroid hormones. Since the odds of a husband and wife both developing this type of autoimmune reaction at roughly the same time are about three million to one, the White House water was tested for iodine. No excess was found, so it seems that George and Barbara were that unlucky couple in three million who simultaneously came down with Graves’ disease due to an autoimmune reaction. Other possibilities, such as a pituitary tumour, were ruled out. Autoimmune reactions can be triggered by a viral or bacterial infection, so the first couple may have shared some infectious agent.
 
The president and first lady received plenty of good-natured advice from the public about what to do, including eating broccoli, which is known to contain goitrogens, compounds that interfere with thyroid function. While this makes some theoretical sense, a grotesque amount of broccoli would have to be consumed for any effect on the thyroid to be noted. In any case, this was one bit of advice the president, having publicly expressed his distaste for the vegetable, was not likely to take. After those remarks, growers dumped truckloads of broccoli in front of the White House in protest, so he certainly would have had enough available had he chosen to indulge.
 
Graves’ disease can be treated with drugs that block the synthesis of thyroid hormone, with radioactive iodide to deactivate the thyroid gland, or with surgery to remove part of the gland. This can result in hypothyroidism, or insufficient production of thyroid hormone, characterized by weight gain, lethargy, fatigue, constipation, cold, clammy skin, diminished sweating, thickened nails as well as coarse and prematurely grey hair. There can also be memory loss and intellectual impairment that may be wrongly ascribed to senile dementia. Hypothyroidism can also be due to a chronic inflammation of the thyroid gland that causes it to become enlarged and impairs hormone production. This is known as Hashimoto’s disease. Whatever the cause of an underactive thyroid, the condition can be treated by oral thyroid hormones, with Synthroid being the most common commercial example.
 
For some unknown reason, thyroid disorders are five times more common in women than in men. In the West, newborns are tested for thyroid problems, but in India some 250 million people are estimated to suffer from iodine deficiency, which is manifested in decreased motor skills, low IQ and poor energy levels. Low levels of thyroid hormones are also believed to cause some ninety thousand stillbirths a year, and nine million children to be born with some form of mental retardation, often referred to as “cretinism.”
 
In North America, salt is commonly iodized, meaning that it has potassium iodide added. But this does present a problem. Iodide is slowly converted to iodine in moist air. Since iodine is volatile, salt would slowly lose its power to protect against goiter. It is therefore common practice to add iodine stabilizers to iodized salt. These are substances that convert iodine back to iodide. Sodium thiosulphate used to be added, but it sounded too chemical and people became worried. So manufacturers switched to dextrose, which is as effective and sounds more innocuous. Sodium bicarbonate is also added because the oxidation of iodide occurs readily in an acid solution but not in a base. Disodium phosphate or sodium pyrophosphate are sometimes used to provide the alkaline conditions. These are also “sequestering agents,” which bind trace metals that catalyze the oxidation of iodide to iodine.
 
Unfortunately, this easy protection against goiter is not being carried out everywhere. In India, because of the humid air, salt is usually sold in large crystals that are resistant to humidity. These are sometimes sprayed with potassium iodate (yet another substance capable of supplying iodine for thyroid hormone production), but that makes the salt look dirty, so people wash the crystals before crushing them. The consequences are tragic.
 
 
 
Frankincense is a tree resin that has long been used in incense and perfume production. Recent research shows that it may also be useful in the treatment of what medical condition?
 
 
Osteoarthritis. The wearing away of shock-absorbing cartilage that protects the ends of bones can result in stiffness and pain as bone rubs on bone. It is not primarily an inflammatory condition, meaning that it is not normally accompanied by swelling, heat or redness. But osteoarthritis can have an inflammatory component as bits of cartilage break off and cause a swelling around the joint. Since extracts of the Boswellia serrata plant, commonly known as frankincense, have anti-inflammatory properties, it comes as no surprise that they should have some efficacy in treating osteoarthritis. Frankincense has long been used in Ayurvedic medicine, mostly for digestive problems, and notably has not been associated with adverse reactions. Its use, however, has generally not involved standardized products.
 
Now, Laila Impex, an Indian pharmaceutical company, has developed a drug known as 5-Loxin from boswellia resin with a reproducible, standardized composition. The major active ingredient is acetyl-11-keto-beta boswellic acid, which is known to interfere with the activity of 5-lipoxygenase, an enzyme that catalyzes the formation of leukotrienes, which are compounds that promote inflammation. Of course, osteoarthritis sufferers want more than theory. And now they may have it: a randomized, double-blind, placebo-controlled trial using varying doses of 5-Loxin has shown evidence of benefit. Seventy patients completed the ninety-day study, with those taking 250 milligrams of the drug every day showing a significant improvement in pain score and stiffness. Furthermore, when fluid was drawn from the subjects’ knees, in those taking the medication, there was a significant decrease in matrix metalloproteinase-3, an enzyme that can break down cartilage. While one cannot make too much of a single study, there is room here for optimism, given that no side effects were noted. And frankincense may have yet another effect—at least in mice. Incensole acetate, a compound found in frankincense smoke, relieves anxiety and depression. I’m not sure how one diagnoses depression in a mouse, but that’s another story. In any case, those wise men bearing gifts of frankincense may have been onto something.
 
 
 
A study showed that a daily intake of two 500-milligram tablets of quercetin, a flavonoid found in apples, was effective in reducing the symptoms of chronic prostatitis. If an average apple contains 0.1 grams of quercetin, how many apples would have to be eaten every day to matc...