Published in Skeptical Briefs volume 27, number 1, 2017.
by Felipe Nogueira
In my last column, we briefly saw that Dr. Paul Offit’ latest book is Pandora’s Lab. As the subtitles explains is about Seven Stories of Science Gone Wrong. The book theme is simple: even though science has done good in the world, every possible invention might have bad consequences. If we accept new discoveries at face value, or to better put it, without the skepticism that science itself has taught us, we might, even with the opposite intention, doing harm. In some cases, avoidable harms; in other cases even more harm than good.
“Science can be Pandora’s beautiful box”, writes Offit. The seven stories covered in the book exemplify it very well. What connected those stories, besides science going wrong, is that they started in history, but their impact can be felt until today. Thus, as Offit shows in the final chapter, their lesson is still unlearned.
The lesson of vilifying saturated fat as the cause of heart disease still lives with us today. As clear explained in the book, heart disease or atherosclerosis happens when either of the coronaries arteries is blocked, interrupting the blood flow, damaging the heart, which occasionally might result in death. The hypothesis that diet impacts heart diseases, recollects Offit, started in 1913 when a Russian study found that rabbits fed large quantities of foods rich in cholesterol (milk and egg yolks) developed atherosclerosis. Thus, the study’s author hypothesized that heart disease might be controlled by diet, specifically, by eating less cholesterol.
Another relevant study was done by Ancel Keys, who in 1950 compared people’s diet in several different countries. He found that countries with greater amount of fat in peoples’ diet, such as Finland, had higher incidence of heart disease. As such, he was the first person to use the term “heart-healthy diet”, urging Americans to restrict their fat intake. In 1961, the American Heart Association recommended to not eat more than 300 mg of daily cholesterol. There was only one problem with these recommendations: “scientific data on the relationship between fat consumption and human health remained, at best, ambiguous”, in Offit’s own words.
While data weren’t clear for radical interventions, restricting diet fat became government policy. Another crusader against fat was Senator George McGovern, who founded a nutrition committee responsible for a report wrote by politicians, instead of nutrition scientists or specialists.
In the 1980s, a non-governmental company called Center for Science in the Public Interest (CSPI) target restaurants and other food companies that used saturated fat based oils. This was a response to several studies that found saturated fat as the culprit of heart disease and that unsaturated fats were good for health. That’s what led us to the great margarine mistake. Following the push against saturated fat, the public reduced the amount of butter consumed, replacing it with margarine. Restaurants and food supply also made changes. They started using partially hydrogenated vegetable oils. As Offit put it, “In the 1980s, partially hydrogenated vegetable oils became the single most product for all baking and frying”.
Foods containing animal fats, such as butter and those oils previously used by industry, are rich in saturated fat. In contrast, margarine (at the time) and partially hydrogenated vegetable oils have great quantities of trans unsaturated fat, or trans-fat. In the 1980s and 1990s, studies linked partially hydrogenated vegetable oils with heart disease. Offit is crystal clear:
“The Harvard School of public health later estimated that eliminating trans fats from the American diet would prevent 250,000 heart attacks and related deaths every year!
Unlike studies of total fat, total cholesterol and unsaturated fat – where findings had been contradictory or inconclusive – no researcher has ever published a paper showing that trans fats are anything other than one of the most harmful products ever made.”
By trying to make us healthier, we ended up creating a much bigger problem. We didn’t know if trans-fat were safe or not, but our desperation to remove saturated fat from the diet certainly has led us astray: “in 2006, an article in the New England Journal Of Medicine declared ‘On a per calorie basis, trans fat appear to increase the risk of coronary heart disease more than any other macronutrient.’”
If that mistake was not enough, Offit brilliantly remember our desire to cure or treat mental illness was even more tragic. In attempt to understand the function of brain areas related to memory tasks, two researchers removed the frontal lobes of two chimpanzees. After the procedure, both chimps didn't remember how to get food. So, the researchers believed frontal lobes were responsible for creating and storing recent memories. But something else had happened. It seemed that one of the chimps didn't care for her recent memory limitation, as if she had "joined a happiness cult", in the words of one of researchers. They believed they had invented a treatment for anxiety.
It didn't require much time for someone trying this procedure called lobotomies in humans. In the late 1930s, several countries like performed lobotomies. One responsible for the apparent success of lobotomies was the neurologist Egas Moniz, who published a long monograph describing the procedure results in his 20 patients. Moniz reported improvements in more than half of it, even though adverse events like vomiting, diarrhea, nystagmus, and disturbed orientation of time and space happened. Surprisingly, Moniz was awarded the Sweden's Nobel Prize for his invention. The consequence was nothing to be awarded for: within four decades, 40,000 lobotomies were performed in the world.
The United States also had their lobotomy pusher: Walter Freeman. His "insight" was making a much more fast procedure, using electroshock for anesthesia and an ice pick. In 1950, Freeman wrote a book reporting the results of many of his “ice pick lobotomies”. While patients had several adverse events (as had happened with Moniz's patients), Freeman concluded his invention was successful. But Offit is clear about the patients:
In a page-turner way, Offit tell us more five lessons of the past. God’s Own Medicine, or the story about the creation and use of opioid pain-killers, appeared in the latest issue of Skeptical Inquirer. We can learn the lesson from those stories to apply them to the present future.
That's what Offit does in the final chapter, for example discussing the problem of overdiagnosis and overtreatment with cancer screening programs. We must recognize as Offit explains that cancer's definition is changing. Not all of the detected cancers are going to kill us. Screening with PSA-test made prostate cancer the most commonly diagnosed non-skin cancer in the United States. But the risk of death due to prostate cancer remains unchanged in the last ten years. Critically, in men with 60 years or more that died from other causes, autopsies found prostate cancer in half of them. A similar situation is seemed in thyroid cancers, which are found in autopsies in one-third of people that had died from something else. The screening for breast cancer, another that in Brazil has a dedicated month to its promotion and awareness, it’s just a bit better because it saves some lives, but not many lives we’d think or like. Only 8 women of 122 benefit from it. The problem is what happened with the others: mastectomy, radiation therapy, chemotherapy with no evidence of benefit. Alarmingly, it’s estimated that 1.3 million women had been diagnosed with a breast cancer that would never killed them.
One clear lesson is to be cautions of anecdotes. Those pushers for lobotomies believed their procedure was saving lives. That’s why we need careful and controlled studies to evaluate the efficacy and safety of interventions. So, Pandora’s Lab main lesson is to apply the skepticism even to science’s new inventions. Actually, accepting new inventions coming from science or not with face value is, in fact, not scientifically. The book beautiful reminds us that one of the big lessons of science is the skepticism and the importance in the promotion of science and critical thinking we do in CSI. The conclusion:
by Felipe Nogueira
“Science can be Pandora’s beautiful box”, writes Offit. The seven stories covered in the book exemplify it very well. What connected those stories, besides science going wrong, is that they started in history, but their impact can be felt until today. Thus, as Offit shows in the final chapter, their lesson is still unlearned.
The lesson of vilifying saturated fat as the cause of heart disease still lives with us today. As clear explained in the book, heart disease or atherosclerosis happens when either of the coronaries arteries is blocked, interrupting the blood flow, damaging the heart, which occasionally might result in death. The hypothesis that diet impacts heart diseases, recollects Offit, started in 1913 when a Russian study found that rabbits fed large quantities of foods rich in cholesterol (milk and egg yolks) developed atherosclerosis. Thus, the study’s author hypothesized that heart disease might be controlled by diet, specifically, by eating less cholesterol.
Another relevant study was done by Ancel Keys, who in 1950 compared people’s diet in several different countries. He found that countries with greater amount of fat in peoples’ diet, such as Finland, had higher incidence of heart disease. As such, he was the first person to use the term “heart-healthy diet”, urging Americans to restrict their fat intake. In 1961, the American Heart Association recommended to not eat more than 300 mg of daily cholesterol. There was only one problem with these recommendations: “scientific data on the relationship between fat consumption and human health remained, at best, ambiguous”, in Offit’s own words.
While data weren’t clear for radical interventions, restricting diet fat became government policy. Another crusader against fat was Senator George McGovern, who founded a nutrition committee responsible for a report wrote by politicians, instead of nutrition scientists or specialists.
In the 1980s, a non-governmental company called Center for Science in the Public Interest (CSPI) target restaurants and other food companies that used saturated fat based oils. This was a response to several studies that found saturated fat as the culprit of heart disease and that unsaturated fats were good for health. That’s what led us to the great margarine mistake. Following the push against saturated fat, the public reduced the amount of butter consumed, replacing it with margarine. Restaurants and food supply also made changes. They started using partially hydrogenated vegetable oils. As Offit put it, “In the 1980s, partially hydrogenated vegetable oils became the single most product for all baking and frying”.
Foods containing animal fats, such as butter and those oils previously used by industry, are rich in saturated fat. In contrast, margarine (at the time) and partially hydrogenated vegetable oils have great quantities of trans unsaturated fat, or trans-fat. In the 1980s and 1990s, studies linked partially hydrogenated vegetable oils with heart disease. Offit is crystal clear:
“The Harvard School of public health later estimated that eliminating trans fats from the American diet would prevent 250,000 heart attacks and related deaths every year!
Unlike studies of total fat, total cholesterol and unsaturated fat – where findings had been contradictory or inconclusive – no researcher has ever published a paper showing that trans fats are anything other than one of the most harmful products ever made.”
By trying to make us healthier, we ended up creating a much bigger problem. We didn’t know if trans-fat were safe or not, but our desperation to remove saturated fat from the diet certainly has led us astray: “in 2006, an article in the New England Journal Of Medicine declared ‘On a per calorie basis, trans fat appear to increase the risk of coronary heart disease more than any other macronutrient.’”
If that mistake was not enough, Offit brilliantly remember our desire to cure or treat mental illness was even more tragic. In attempt to understand the function of brain areas related to memory tasks, two researchers removed the frontal lobes of two chimpanzees. After the procedure, both chimps didn't remember how to get food. So, the researchers believed frontal lobes were responsible for creating and storing recent memories. But something else had happened. It seemed that one of the chimps didn't care for her recent memory limitation, as if she had "joined a happiness cult", in the words of one of researchers. They believed they had invented a treatment for anxiety.
It didn't require much time for someone trying this procedure called lobotomies in humans. In the late 1930s, several countries like performed lobotomies. One responsible for the apparent success of lobotomies was the neurologist Egas Moniz, who published a long monograph describing the procedure results in his 20 patients. Moniz reported improvements in more than half of it, even though adverse events like vomiting, diarrhea, nystagmus, and disturbed orientation of time and space happened. Surprisingly, Moniz was awarded the Sweden's Nobel Prize for his invention. The consequence was nothing to be awarded for: within four decades, 40,000 lobotomies were performed in the world.
The United States also had their lobotomy pusher: Walter Freeman. His "insight" was making a much more fast procedure, using electroshock for anesthesia and an ice pick. In 1950, Freeman wrote a book reporting the results of many of his “ice pick lobotomies”. While patients had several adverse events (as had happened with Moniz's patients), Freeman concluded his invention was successful. But Offit is clear about the patients:
"would lie in their bed like 'wax dummies' and have to be turned constantly by visiting nurses or family members to keep from getting bedsores. All were profoundly inddiferent to their surroundings. They didn't seem to care about anything. Worse, they had lost any sense of decorum".Despite serious adverse events (3% died from bleeding and other 3% faced permanent seizures), no medical society or organization stood up against lobotomies. According to Offit, it was the invention and use of psychoactive drugs that lessen the number lobotomies performed.
In a page-turner way, Offit tell us more five lessons of the past. God’s Own Medicine, or the story about the creation and use of opioid pain-killers, appeared in the latest issue of Skeptical Inquirer. We can learn the lesson from those stories to apply them to the present future.
That's what Offit does in the final chapter, for example discussing the problem of overdiagnosis and overtreatment with cancer screening programs. We must recognize as Offit explains that cancer's definition is changing. Not all of the detected cancers are going to kill us. Screening with PSA-test made prostate cancer the most commonly diagnosed non-skin cancer in the United States. But the risk of death due to prostate cancer remains unchanged in the last ten years. Critically, in men with 60 years or more that died from other causes, autopsies found prostate cancer in half of them. A similar situation is seemed in thyroid cancers, which are found in autopsies in one-third of people that had died from something else. The screening for breast cancer, another that in Brazil has a dedicated month to its promotion and awareness, it’s just a bit better because it saves some lives, but not many lives we’d think or like. Only 8 women of 122 benefit from it. The problem is what happened with the others: mastectomy, radiation therapy, chemotherapy with no evidence of benefit. Alarmingly, it’s estimated that 1.3 million women had been diagnosed with a breast cancer that would never killed them.
One clear lesson is to be cautions of anecdotes. Those pushers for lobotomies believed their procedure was saving lives. That’s why we need careful and controlled studies to evaluate the efficacy and safety of interventions. So, Pandora’s Lab main lesson is to apply the skepticism even to science’s new inventions. Actually, accepting new inventions coming from science or not with face value is, in fact, not scientifically. The book beautiful reminds us that one of the big lessons of science is the skepticism and the importance in the promotion of science and critical thinking we do in CSI. The conclusion:
we need to approach all scientific advances cautiously and with eyes wide open – and to make sure that we learn from our mistakes and aren’t paralyzed by them.
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