All About Multiple Sclerosis

More MS news articles for June 2003

'We do not know'

June, 2003
James Le Fanu
Financial Post
In their quest to cure a wide array of human ailments, scientists have served up a plethora of pseudo-explanations instead of simply saying the following four words

We live in the Age of Science with more scientists practising today than have ever existed -- in total -- in the history of the universe. But we live also in the Age of Junk Science with more false inferences, pseudo-explanations and intellectual deceits than ever before.

Why should this be? The ascendancy of science to its dominant position in Western culture has spawned, almost inevitably, the aberration of scientism, the belief that there is nothing science cannot know, that every aspect of the natural world must ultimately be explicable in materialist terms. For is this were not so, if -- say -- the origins of life or the workings of the brain were inscrutable and inaccessible to human reason and understanding, then the authority of science as the exclusive source of reliable knowledge would necessarily be diminished. In these circumstances, some, any, explanation it seems is better than having to utter those four words -- so simple, yet so full of meaning -- "we do not know." Herein too lies the key, the master plan, by which junk science can be unravelled.

Junk science comes in protean forms but its most readily recognizable manifestation is the litany of confusing and contradictory "causes" of disease (coffee does, or does not cause cancer of the pancreas or congenital defects or heart disease; alcohol does, or does not cause breast cancer; keeping pets is, or is not, associated with multiple sclerosis and so on ad infinitum) about which we learn almost daily in our newspapers and on the television.

This source of this junk science, with its plethora of pseudo-explanations, lies paradoxically in the extraordinary scale of the post-war medical achievement. Looking back now over the past 50 years, the most striking consequence of the discovery of antibiotics and steroids and the 4,000 other drugs that created the therapeutic revolution and the assault on the infectious diseases of childhood and open-heart surgery, transplantation and much else besides has been to squeeze the burden of illness to the two extremes of life. Infant mortality has fallen tenfold from around 50 to an irreducible minimum of four deaths per 1,000 live births, almost all of which can be accounted for by severe congenital abnormalities, prematurity or Sudden Infant Death Syndrome. Moving to the other end of the age spectrum from 60 onwards, we all become vulnerable to the chronic degenerative illnesses -- furred up arteries, arthritis, cataracts and most cancers -- that medicine can do much to alleviate but cannot cure. Thus, for the first time in human history, we are privileged to live in a society where for five decades or more, from infancy through to late middle age, we are freed of the threat of untimely illness.

This interpretation of the post-war achievement does however bring into focus the very important exception to this trend -- those illnesses that are not age determined but from the teenage years onwards strike apparently randomly and out of the blue: multiple sclerosis, rheumatoid arthritis, diabetes, Parkinson's and dozens of others. The unifying feature of all these conditions is that we do not know their cause. There must be some explanation for why, as in MS, the insulating sheath around the nerve should become inflamed, or why, as in rheumatoid, the membrane lining the joints should become so red and swollen. There may be a genetic component as shown by an increased risk in identical twins. There may be an environmental component. But extraordinary as it seems, we cannot pinpoint the underlying cause with certainty, as we know that the TB bacillus causes tuberculosis and smoking causes lung cancer.

Indeed this situation is in many ways analogous to that which prevailed in the mid-19th century when there was a plethora of equally recognizable diseases of unknown causation: anthrax, typhoid fever, suppuration, cholera, diphtheria, tetanus, pneumonia, gas gangrene, botulism, dysentery and syphilis. Then the German microbiologist Robert Koch and his colleagues, equipped with their microscopes and some chemical dyes with which to stain biological tissues, discovered the precise bacteria responsible for each and every one.

Similarly, it is reasonable to presume that there must be some other class of biological agents that could explain why one person gets multiple sclerosis, another rheumatoid arthritis, a third schizophrenia and so on.

The same point can be made more readily by trying to imagine what difference it would make if we did know the cause of these diseases, for then it would be possible to devise some means of preventing them or design a drug to counteract them.

This is best illustrated by the case of peptic ulcers attributed variously over the years to stress, anxiety, faulty diet, hot foods, insufficient rest, anything, in short, that might explain its presumed mechanism of increased acid secretion in to the stomach. However in 1984, a young Australian researcher, Barry Marshall, scrutinizing biopsies of the stomach wall, noted a "previously unidentified curved bacillus" subsequently named helicobacter (literally helix shaped). From that moment, the plethora of pseudo-explanations evaporated. Once peptic ulcers were shown to be an infectious disease, they became curable by the simple expedient of prescribing antibiotics.

The failure to identify the equivalent of the "unidentified curved bacillus" for multiple sclerosis, rheumatoid and so on lies at the root of so much medical junk science. The phenomenal success of post-war medicine has encouraged doctors to believe they know more than they really do, and to resist saying "we do not know." Rather, taking their lead from the manner in which lung cancer incriminated smoking, they have sought causes in people's everyday lives. Take two groups of people, one with the disease (such as lung cancer) and one without. Next compare their lives and any obvious difference (such as smoking habits) can plausibly be implicated as its cause.

The tens of thousands of studies that have applied this technique over the past few decades have ended up implicating virtually every aspect of people's everyday lives -- alcohol, yogourt, mouth washes, coffee, red meat, electricity pylons and mobile phones -- in some disease or other.

This type of research can only measure that which is measurable in people's lives. It cannot, by definition, uncover hitherto unknown biological phenomena such as the new bacterium helicobacter implicated in peptic ulcer. Put another way, if -- as is likely -- the cause of MS and all those other non-age-related illnesses of middle age have nothing to do with lifestyle, the epidemiological explanations for them will be in error.

This is hardly a novel insight. Nearly 10 years ago the prestigious journal Science, in a much-cited article, Epidemiology Faces its Limits, observed how "the search for subtle links between diet, lifestyle or the environment and disease is an unending source of fear, but yields little certainty." The public is exposed to a "mind numbing array of potential disease causing agents from hair dryers to coffee ... the pendulum swings back and forth resulting in an epidemic of anxiety." And that epidemic will continue until -- if ever -- someone finds the unifying biological explanation for most common illnesses.

James Le Fanu is a medical columnist with The Telegraph newspapers and author of The Rise and Fall of Modern Medicine, published by Little Brown.

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