Field of Science

Chemophobia: The Boy with a Thorn in His Joints

I'm at ScienceOnline2013 where Carmen Drahl and Dr. Rubidium just finished running a terrific session on chemophobia: how can we bridge the gap between "better living through chemistry" and ads for "chemical-free sleep aids." The thrust of the session was not how to convince people chemistry and chemicals are good, but more about how to inject nuance into the public conversation. Chemicals have risks and benefits — and of course, are unavoidable. But we current view chemical as synonymous with toxic, hazardous, unnatural or just plain bad.

What are the roots of this cultural shift? Can understanding these help scientists and writers communicate more clearly and in the end help people not only understand what is in their "stuff" — chemicals, it's all chemicals — but give them tools to work with and make decisions about the materials that make up the world — chemicals. As @docfreeride (ethicist Janet Stemmwedel) noted at another session yesterday, we can agree on facts, and still make different decisions based on them.

Today's New York Times has a perfect example of the various ways chemophobia presents in the Magazine: The Boy with a Thorn in His Joints. The piece chronicles Susannah Meadow's search for an effective treatment for her son's rheumatoid arthritis. She agonizes about the decision to give him methotrexate (which in high doses is used in anticancer treatment) and turns to alternative treatments, in particular four-marvels powder. There are intense arguments with the pediatricians and with her husband over the issue. I was struck by two things in this piece. First, the language Meadows uses to limn the controversy, and second her ignorance, not so much of the chemistry that is in your face (methotrexate), but of the ways in which chemistry is couched in alternative cultural schemes(four-marvels powder).

It makes me wonder how chemophobia is linked to the language we use to talk about it. It can be nearly impossible for an non-chemist to figure out what methotrexate is (beyond "a chemical"). The very name sounds harsh. Four-marvels powder is easy to parse: a powder with four effects. Its name rings with hope.

I also wonder if we worry more about stuff we are familiar with, we've heard more talk on the street about their risks. So we obsess about vaccines, because we hear and read about the side-effects of vaccines, but how many people know anyone who has died of measles? (One of my sister's friends died of measles when I was a child, before there was a vaccine.) So we get in the Times' piece "I was desperate to find a way...without the drugs." pushed up against "[My husband] has always been more comfortable with pharmaceuticals, more trusting in general."

Of course, four-marvel powder is a pharmaceutical, it's just from a different pharmacopoeia — the traditional Chinese — than the one Meadows or her husband is familiar with. Meadows can read the package insert with information on the side-effects of methotrexate, she may be unaware of the routine advice given in Chinese medicine programs (and yes, there are formal academic programs in Chinese medicine, e.g. at Nanyang Technical University) about four-marvels powder (it should never be given to pregnant women, for example, which might make you hesitate before giving it long term to infants or young children).

The session at SciOnline2013 brainstormed about effective ways to help people develop a better sense of nuance around what is a chemical and what are the risks of this particular chemical? What strategies do you think would be most effective?

13 comments:

  1. It's not so much a confusion about word definitions as it is a profound loss of trust in the system. I think people use "chemical" to mean "manufactured" or "synthesized."

    You can argue that four-marvels powder is manufactured as well (it is), but it's perceived as product of an ancient wisdom tradition instead of a compromised and corrupt modern artificial culture.

    There's a certain degree of romanticism in that, but we live in a media environment where we are bombarded with pharmaceutical marketing, over-hyped health studies, and stories about medical research corruption.

    I'm not surprised that a lot of people respond to medicine the same way they do politics: look for a way to chuck the whole sorry system. Medical science has some reputation repair ahead of it. Education is going to be a part of that, but it's not going to be effective until people feel they can trust the process more.

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    1. There are a lot of issues around this, beyond the language issue I was try to tease out here. Trust is a big one. I get why people distrust the monolithic construct "the chemical industry" but wonder why we often don't ask the same (good!) questions about the alternatives.

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  2. Just read this over on Slate. Great article, and one that I will cite when people gush about how all herbal remedies must be safe because they are, you know, herbal. Thanks!

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  3. Hi Michelle,

    I got here from your Slate article, which I thoroughly enjoyed. One small (maybe significant) point about quercetin: although you're correct that at least one MSDS cites 125 mg/kg as acute oral LD50 in mice, this value seems to be way too low, and I'm not sure where it came from. Over on Cayman's site their MSDS lists 159 mg/kg for mice and 161 mg/kg for rats. Again, weird. Typical dosages administered in studies evaluating the prophylactic effect of quercetin on toxin exposure are in the 50-100 mg/kg range, and in rats at least two studies have been published using 300 mg/kg/day for the lifetime of the animal, where no overt toxic or genotoxic effects were observed. You can find these easily on Google Scholar. Variations in gut bioavailability and hepatic metabolism will of course yield different values for people but these rodent numbers are just too low.

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    1. Thanks for the helpful peer review! I've stashed the better references, and will try to put some links up later.

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  4. Hi - Got here from your Slate article, the premise of which I think is important, and worth thinking about and discussing. I wish however you had stuck to more consistent arguments when building your case. Methotrexate is also very powerfull and contrindicated for pregnant women (http://www.rxlist.com/trexall-drug/overdosage-contraindications.htm) making your emotional statement about pouring quercetin down a son's thoat - a canard. Same goes for Methotrexate. So I wish instead you fixated on the important point: that it's better to be fully informed and not just anesthetize ourselves with feel-good language. Your choice sets up a false premise that quercetin is more dangerous on that condition alone (pregnant women). That disingenuous notion, doesn't do justice to your other valid points.

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    1. Monica, that's exactly the point I had hoped to make. I didn't mean to imply that quercetin was more dangerous than methotrexate, just that it, too, had risks. They are both drugs, they both have risks. I wouldn't give my child either without doing the best I could to assess the risks on an even footing.

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    2. I enjoyed this post immensely. In my view, the central point -- that conventional and "natural" drugs can differ far more in perception than in function -- is an important one, and well-presented here. As it happens, I have been taking 15 mg of methotrexate weekly for over ten years as treatment for rheumatoid arthritis. I tolerate it well, and it has stopped my joint degeneration in its tracks. My only regret is that I did not start earlier. Ironically in this context, I was initially reluctant to start methotrexate precisely because its side effects are so thoroughly reported. I get a liver panel several times a year, and consistently test fine, but the only reason I get the test is that my rheumatologist knew to order it. What are the odds that my local traditional Chinese apothecary would tell me to get my liver tested if I took Four-Marvels powder?

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    3. A well trained traditional Chinese physician might indeed know to order a liver panel (or otherwise be on the alert for such side-effect), it's when these drugs (which can be effective) end up being self-prescribed that the troubles can really begin.

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    4. A good and measured reply, but it serves only to increase my concern. My experience with people who favor alternative medicine has been that they uniformly reject medical authority from any source and prefer to self-prescribe, well, anything and everything. What is your impression?

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  5. Michelle,,
    Thanks for the thoughtful blog post and article over at Slate. I agree with you that people often think "natural" is good, even though the components of many natural products can also be found in chemically derived compounds.

    However, I think the larger point of the NYT article was the the food allergens removed from the boy's diet calmed down his arthritis, not the Chinese herbal remedy (which may have helped with his pain, but not the reversal of his arthritis). I was left with the understanding that a gluten-free, dairy-free diet was the only aspect of the boy's treatment that took, and that he had flare ups when he consumed wheat or dairy.

    So, even though the writer did allow her son to take the Chinese herbal medicine, I don't think she attributes his cure to it, but rather to the elimination of some of the top food allergens.

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  6. Michelle,

    First, let me say that this is an excellent post (both here and your article on Slate). I feel like much of what you identify here in terms of visceral public reactions (including highly selective focus on what constitutes "chemicals") has tremendous carry-over in many other technological fields (including nuclear technology, where I reside). I'd be very interested to hear your follow-on thoughts as to how to facilitate better communication strategies that cut through some of these biases concerning risk within the chemistry field, as it seems like there would be a great deal of applicability to other fields (particularly nuclear energy, etc.)

    Something I'd point out is work by Dan Kahan on his Cultural Cognition project (http://www.culturalcognition.net) - basically Kahan has been doing social science research as to where polarizations over risk perception arise from (and subsequently, getting back to how we can produce the kinds of science-informed discussions of risk like you're talking about - i.e., where individuals may still reach different conclusions about how to balance the risks inherent to modern technology while fundamentally coming from the same understanding of what those risks *are* - like the issues you bring up here.)

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    1. The Cultural Cognition website came up several times at ScienceOnline 2013, and is a fascinating resource.

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