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Over 100 years ago we could have been peddling snake oil. My “Wellcome’s pharmacists diary”, dated 1912, indicates that just before the 1914–18 war we would have been handling such niceties as “lead and opium lotion” or “pills with arsenic and strychnine”.
In this and in the 1939–45 war, the government of the day issued
troops a daily cigarette ration. This only goes to illustrate that there
are fashions in medical treatments, government attitudes to smoking and
health as in everything else. As we prescribe and dispense we should
always realise that what is considered best practice today may well be
laughed at tomorrow. Was it not Jacob Bell who said “Yesterday’s
charlatan is tomorrow’s professor”?
About a year ago, in the BMJ’s obituary of David Horrobin, it was
written “He may prove to be the greatest snake oil salesman of
his age” (BMJ 2003:326:885l).
Yet, David was one of the most able men I have ever worked with in 30
years in the pharmaceutical industry
and there are certainly others I have come across better deserving the
snake oil salesman tag. David was an imaginative thinker, and surely
we need more original thinkers in medical research. He liked to encourage
others to think, too, by starting the journal Medical
Hypotheses. He
was wise enough to see that any new scientific theory was likely to need
developing into something far more complex than initially envisaged.
This is particularly true in medicine, where acceptance of new ideas
over the tried and tested is slow and innovative approaches are stifled
by organisations, such as the National Institute for Clinical Excellence,
producing rigid guidelines. Inevitably David’s unconventional approach
to product development rubbed the medical establishment, the regulators
and, indeed, many others up the wrong way, but it is worth reading the
incredible feedback saga after that infamous obituary. I am sure David
would have been amused that he could still create a stir even after his
passing.
After some 40 years of clinical investigation and developing pharmaceutical
products, David suddenly found himself in the unenviable situation of being
diagnosed with a terminal disease —advanced
mantle cell lymphoma. After all those years of conducting studies on
patients, he saw things quite differently, now, sadly, from a desperate
patient point of view. He was man enough to write about this as a personal
view in the Lancet (2003;361:695–7), which was published only five
weeks before he died. This paper should be compulsory reading to anyone
working in clinical studies, but I am sure it will not be because of
the motivation and vested interests of those organising such trials.
We need more like David, who, like all good scientists, continually question,
not just accept the “official” line and accepted theory.
So, is there an increasing intolerance of these individuals who think,
question or behave differently from the norm? Have we advanced much as
a civilisation in 400 years since Copernicus had a theory about the earth
revolving around the sun? He was afraid to publish in case it cost him
his life. Galileo, who later proved the theory in favour of the establishment’s
accepted Ptolemy theory that the earth was the centre of the universe,
was imprisoned for his trouble. More recently, was Prusiner not ridiculed
over his prion disease theory that there are proteins without nucleic
acid, before he was eventually awarded the Nobel prize in 1997? Do we
not need those individuals who questioned the efficacy of snake oil or
ask why it is, for example, that a first-line antidepressant treatment
using current “best practice” more often than not has no
useful clinical effect, rather than blithely accepted the “breakthrough” claims
made by the manufacturer? What is interesting is that whatever we believe
in, to change our mind about that belief, or even accepting that it just
plain wrong, is something we humans seem to find extremely difficult
to do. Being a good scientist is about keeping an open mind and being
prepared to admit you could well be wrong. That is the most useful thing
I learnt from working with David.
— Contributed
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The
Pharmaceutical Journal