One of the oldest scientific societies in existence, The Royal Society, has been awarding distinguished individuals with the Copley Medal since 1731, one hundred and seventy years before the first Nobel Prize. The list of Copley Medal recipients includes such recognizable names as Benjamin Franklin, Joseph Priestly, Charles Darwin, Thomas Huxley, Albert Einstein, Max Planck, Niels Bohr, Francis Crick, James Watson, Stephen Hawking, and Peter Higgs (The Royal Society 2016).
Dorothy Hodgkin, also a Nobel laureate in Chemistry, received the Copley Medal in 1976. Among her tremendous scientific contributions, Dr. Hodgkin pioneered the use of X-ray crystallography with complex biological molecules, spawning the field of protein crystallography (Ferry 2014). In her lifetime, she deciphered the atomic structure of insulin, vitamin B12, and penicillin.
Dr. Hodgkin also suffered from an autoimmune disease, rheumatoid arthritis. Diagnosed in her early twenties, Hodgkin spent most of her scientific career with episodic pain and inflammation and eventually an agonizing onset of deformities. The disease would be crippling, though she would continue to travel the globe promoting science and international human rights until her death in 1994.
Coincidentally, X-ray crystallography would eventually be used to decipher the structure of tumor necrosis factor alpha, a cytokine that plays a role in systemic inflammation (Eck and Sprang 1989). Current biologic drugs such as entanercept and adalimumab (Enbrel and Humira) inhibit the production of tumor necrosis factor and are common treatments for rheumatoid arthritis (often in combination with other disease modifying drugs). Advanced forms of X-ray crystallography, called macromolecular crystallography, are currently used in various pharmaceutical developments (Scalip 2006).
Science and History Get Personal
Similar to Dr. Hodgkin, I also have rheumatoid arthritis (RA). Living with it is no easy task. Physically it can be excruciating, defeating, and endlessly frustrating, as the most mundane tasks can become massive obstacles. Psychologically it is also brutal. Though difficult to quantify, RA patients suffer from bouts of depression and diagnosable major depressive disorder at a rate greater than the general population (Matcham et al. 2013).
Most surprising to me is how difficult the disease can be to live with socially. In my range of friends, family, and acquaintances, I am unfortunate enough to have a plethora of self-appointed experts on treating my illness (or denying that it exists entirely). Yet most of these individuals don’t know the difference between aches and pains due to wear and tear and systemic inflammation.
Here are a few implausible things I have heard while telling others about rheumatoid arthritis:
“Have you tried cherries?”
“All diseases are an illusion of Western medicine.”
“Doctors are keeping you sick with those drugs.”
“My massage therapist recommends turmeric and crystals for inflamed joints.”
“Just imagine the outcome you want, and it will come.”
“Have you tried essential oils? My bruises heal way faster and my wife just became a vendor.”
And so on …
Raise Your Red Flags!
The most immediate sign of a likely pseudoscientific intervention is when the same treatment is claimed to have broad effects for a vast array of conditions that share no common biological pathway or relationship. My immune system is attacking the synovial lining of my joints. If treatment X, for example, also cures/helps schizophrenia, depression, back pain, dental pain, nausea, irritable bowls, constipation, headaches, allergies, dysentery, sciatica, sprains, tennis elbow, hay fever, morning sickness, hypertension, hypotension, facial pain, stroke, and rheumatoid arthritis, it must be truly miraculous (Evidence Based Acupuncture 2016). If it really can do all of these things, what are the mechanisms of action? What is the biological pathway that ties all of these together?
Contrast this with the very modest—and very precise—claim that tumor necrosis factor plays a role in systemic inflammation. When inhibited, it can slow disease progression in a tested percentage of individuals with rheumatoid arthritis, Chrohn’s disease, psoriatic arthritis, juvenile arthritis, inflammatory bowel disease, ankylosing spondylitis, and psoriasis because they are all rheumatic inflammatory diseases (American College of Rheumatology 2016). Even without the research on efficacy rates in random clinical trials, juxtaposing the extremely broad and miraculous claim having no known mechanism of action with the modest claim that has an objectively known biological pathway should elucidate the general concept of plausibility for those who push alternative medicine.
So Why Is This Important?
What I see playing out is a professional turf war, where tropes of ethnocentrism, closed-mindedness, and dogmatism are ways of taking knocks at scientific knowledge if it excludes one’s deeply held view. The risk of making testable claims is having one’s claims tested and found wanting. If publicly funded research is really about potentially benefiting patients like me, then scientific research based on plausibility—not continued testing of alternative interventions that are implausible and perform no better than placebo or sham controls—should be the way forward. Not all ideas are equally valid and deserving of continued inquiry. Special pleading for more research dollars when systematic reviews have shown no efficacy greater than expectation effects in the most stringently designed experiments is not about the potential benefit to those who suffer.
- The American College of Rheumatology. 2016. Available online at http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Anti-TNF.
- Eck, M.J., and S.R. Sprang. 1989. The structure of tumor necrosis factor-alpha at 2.6 A resolution. Implications for receptor binding. Journal of Biological Chemistry 264(29): 17595–605. Available online at http://www.ncbi.nlm.nih.gov/pubmed/2551905.
- Evidence Based Acupuncture. 2016. Available online at http://www.evidencebasedacupuncture.org/who-official-position/.
- Ferry, Georgina. 2014. Dorothy Hodgkin, A Life. Bloomsbury Reader, London.
- Matcham, F., L. Rayner, S. Steer, et al. 2013. The prevalence of depression in rheumatoid arthritis: A systematic review and meta-analysis. Rheumatology 52(12): 2136–2148.
- The Royal Society. 2016. Available online at https://royalsociety.org/grants-schemes-awards/awards/copley-medal/.
- Scalip, G. 2006. Structural biology and drug discovery. Available online at https://www.ncbi.nlm.nih.gov/pubmed/16796557.