Every so often I like to stray outside my comfort zone. You won’t find me jumping out of airplanes, but as a scientist, I do like to keep an open mind about things I know nothing about.
A hoarse of a different color: Pangdahai to the rescue?
My most recent experiment with the unknown has involved Chinese medicine. I’ve been struggling with periodic laryngitis for weeks now, and with a band gig this past weekend requiring me to be in good voice, I had tried pretty much everything Boots the Chemist had to offer. In fact, a few of my labmates swore they could sense my imminent arrival by the menthol and eucalyptus wafting down the corridors.
One morning our Chinese PhD student (and also a fully trained medic) brought in a small packet containing a handful of strange, furry-brown nut-like objects: Pangdahai – the dried seeds of the Asian tree Sterculia lychnophora. A ‘cold’ medicine, he informed me, to counteract the ‘heat’ of inflamed vocal cords.
Now, I don’t know much about the proposed explanations behind Chinese medicine, a lot of which sound to my untrained ear more metaphorical than mechanistic. But I do recognize that many of our most important Western drugs, from aspirin to taxol, come from plants, so there is no reason to think that with a few thousand years of experimentation, the Chinese might not have come up with some interesting botanicals themselves. After all, when the Neijing Suwen (_The Basic Questions of Internal Medicine_) was purportedly written around 2600 B.C., my ancestors were busy thwacking each others’ heads off with the latest must-have gadget: the bronze sword.
And then of course there’s that line from the 1987 film The Lost Boys: “Tell me, Michael, how could a billion Chinese people be wrong?”
My willingness to give Chinese herbal remedies a try was recently boosted by a Nature paper from Laura Parton and Bradford Lowell at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston which showed that genipin, derived from gardenia fruit and used in Chinese medicine for centuries against Type II diabetes, actually exerts its molecular mechanism by blocking UPC2, a protein that inhibits glucose sensing in the pro-opiomelanocortin neurons of the hypothalamus (doi: 10.1038/nature06098). Urban myth has it that a Chinese post-doc in the lab persuaded Lowell to let him give genipin a try in their system.
So. Pangdahai. Put the seed in boiling water, and allow it to bloom into a brownish-red gelatinous mass about eight times its previous size. Drink five changes of water, the second being the most potent. Not without some degree of trepidation, I might add. The result? It made my face tingle, and it felt pretty nice on my throat.
I’m not, however, entirely convinced it felt any nicer than hot water alone. Now where did that ‘control me’ get to?
I’m such a science geek. I read periodic laryngitis and my first thought was ‘per-iodic? That must hurt‘. Then I fork()ed a process that started wibbling about atomic numbers. . .
I really, really must go fishing.
My dear Richard, I have a little potion that might help for that!
I’ve spent the last four days trying to wrangle perl code. I’d like to see your complementary therapies deal with that.
Heh. Homeopathic perl. It’s so diluted there’s none left.
The compilation errors must be positively weightless. Our French post-doc is teaching me about macros – unfortunately they’re written in French, which doesn’t help.
Seriously, have you ever tried Chinese medicine for anything? Did it work?
Macros shmacros. I’m learning about multi-threading. The code works too, which is an added bonus for a Friday afternoon.
No, never tried Chinese medicines. Been happy so far with the big 3 ‘A’s of antibiotics, aspirin and aqua vitae .
Jenny, I think a lot of your laryngitis is caused by the fact that you are a driven woman who works far too hard. I have a feeling that stress contributes to, or exacerbates, the symptoms of illness far more than most people imagine.
When I was revising for my BSc finals at Leeds University I was crippled with back ache so bad I could hardly walk. My best friend had tonsilitis so dreadful that he was confined to bed and had to sit his finals in isolation. But when the results were posted, my back pains melted away as if they had nver been, as did my pal’s tonsilitis, and we were fit enough for an energetic hike up Ilkley Moor, bah’t ‘at.
It is true that upon completing my last song at the gig (a throat-ripping rendition of ‘Seattle’ by Public Image Limited), my hoarseness had entirely vanished. This made me suspect that I had been perpetuating the sore throat by coddling it when what it had really needed all along was the Johnny Rotten treatment.
But there might be something in what you say. I don’t think of myself as hypochondriac, but I suppose the mind is a powerful thing. Maybe acupuncture works partially because it forces you to lie absolutely still for an extended period of time! (And pills, because it forces you to swallow a lot of water.)
Ben Goldacre has interesting gen on http://www.badscience.net/index.php?s=acupuncture .
Executive summary: it works, via some sort of placebo effect.
Your Pangdahai seeds look very familiar… I was dosed with all sorts of Chinese herbal remedies the first 17 years of my life. Most tasted pretty awful and were accompanied with strict instructions to “drink the whole bowl as it is very expensive and good for your lungs/mind/chi”. I think they were effective in that I recovered very quickly so that I would not have to consume more. Get well soon!
I am a strong believer in the placebo effect, but because I believe in it, I usually end up convincing myself that things actually aren’t working because I am too hyper-aware of the fact that the placebo effect is probably in play…if that makes any sense!
Li Kim, you obviously turned out great, so what a great endorsement for the method!
We used to have a Western medicine that worked the same way as Li Kim’s ‘effective… so that I would not have to consume more.’ It was a large spoon of castor oil. I’m not old enough to have suffered it (honest), but I suspect it had the same combination of fear and placebo.
What we really need is a single universal homeopathic/Chinese medicine pill that works courtesy of the placebo effect. It would save a lot of time and money going to alternative practioners and be just as effective.
I love Wikipedia. Brian’s post inspired me to look it up, and I stumbled over this lovely subheading: “Castor oil: Use as a means of intimidation in Fascist Italy”.
You can’t trick the placebo effect like that, can you? What we need is to eliminate the middleman and work out how to stimulate the effect directly – it would be more effective that way.
I am a strong believer in the placebo effect, but because I believe in it, I usually end up convincing myself that things actually aren’t working because I am too hyper-aware of the fact that the placebo effect is probably in play…if that makes any sense
heh, That makes a lot of sense, and I do wonder the same thing.
Are you mocking me? 🙂
All this reminds me I forgot to take my fish oil today. I used to think that the placebo effect of omega-3 was keeping me from getting colds, until I ended up with that stinking cold. So now I just have to rely on its (hopefully) bona fide effects!
This time, no. . . 😉
p.s. your Goldacre link doesn’t work. (Maybe you got foiled by the dreaded curly quotes?)
The thing I find so interesting about the placebo effect is that it works for so many different things. How can you explain going to an acupuncturist to help you get pregnant and it working, for example, just as well as it may help you with backache or piles? What is the ultimate target? The immune system? Or something more ephemeral? Is anyone studying this, the molecular mechanism of placebo?
I once asked a drug company chemist why more effort wasn’t spent idenfitying the active ingredients in various “natural remedies.” He explained that because natural remedies have so many different chemical species present, the effort to identify which are actually effective is prohibitive.
To identify whether a placebo effect is at work for this specific remedy, someone would have to fund the study. But, since it would be difficult to earn too much money off from something that couldn’t be patented, only the government would be likely to fund such a study.
As for the Pangdahai seed, I have used it and it worked wonders. Had caught a cold while in Shanghai, and had lost my voice. After drinking hot water steeped with this seed, I could talk in a nearly normal voice for about 3 hours.
Hi Robert. Interesting take on the big pharma motivations. But why do you think that discovering the molecular mechanism of placebo couldn’t lead to a marketable (and indeed very lucrative) drug target? If it’s a new pathway and there is no prior art, then there would be no barrier to patenting it. It could be the magic bullet to enhance general health and well-being.
Would it be a new pathway and would there be no prior art? The placebo affect has been around for quite awhile. For example, what if specific conditions and underling mechanism could be identified when saying “Hail Mary” would produce positive health effects. This would provided a scientific explanation for previously unexplained observations. But, the award of a patent for saying “Hail Mary” would be unlikely.
i think that it is right medicine for your laryngitis. maybe there is a difference from different culture. get well soon!
Robert, perhaps you have misunderstood me. My basic assumption is that the placebo effect, like any other physiological manifestation, has its basis in some common biochemical or neurochemical pathway – probably the latter. One wouldn’t patent what causes the effect (the ‘hail Mary’) – one would circumvent this and try to intervene directly with the circuitry in question. Having written a few patents myself, I know that even if the neurons or neurotransmitter in question turns out already to be known, if you find a new application for a pre-existing pathway, and ‘more preferably’ (a little patent joke there for those in the know), a new drug to do this, it is patentable if you phrase your claims the right way.
Thanks for the tip, Lyntsing. There seemed to be quite a few options for sore throat but my colleague was convinced the Pangdahai was the right one. He also said that he had to use stuff straight from China because he thinks most of the Chinese medicine shops in London are dodgy. Fortunately I am now healthy once again!
Damn. Curse Nature Network for ignoring years of HTML development. . . the link is http://www.badscience.net/index.php?s=acupuncture but the ‘?’ seems to be screwing up this broken system. OK, this seems to be clickable: http://www.badscience.net/index.php?s=acupuncture
Proper controls for Pangdahai might include hot water alone, hot tea (because that really helps in my sample of n=2. . .), hot squash, or garlic and blackberry vinegar (seriously).
THe molecular basis of the placebo effect is a good one. I’d recommend looking at serotonin and endorphin and their affects.
Or even their effects. (Sorry, but I owe you one! Or two, rather.)
Yup, good ideas, but it would also be interesting if it was something really exotic, like a cluster of heretofore unappreciated neurons.
How long after taking the garlic and blackberry vinegar until you are fit to breathe in mixed company? (And what are the ratios?)
snort
Um, dunno about the social effects (gah, I was really off there, wasn’t I?) of garlic & bbv, last time I took it I was married and the time before that I was a callow youth of 14 and didn’t care 🙂
The recipe, handed down to me by, um, me, is:
Take a clove of garlic. Crush it in a mug. Add enough boiling water to cover it. Add BBV (homemade, natch) to taste, and sugar if you’re a wimp.
Drink. Don’t expect to make any new friends.
I think it works by making your head feel like it’s about to explode, and by the time you regain sensation in your throat the bugs are suing for peace.
Fantastic, I am definitely going to try that next time!
My favourite bit of psychoneuropharmacology is the ‘nocebo’ effect seen in double blind clinical trials when doctors warn folks that the tablets they’re taking could cause “nausea, tiredness, irritability etc, etc”. The control groupers much more often than they ought to for a bunch of folks on sugar pills frequently tick yes, yes, yes to the lot!
Sara, that’s fascinating – I’ve never heard of nocebo before. I suppose there’s no reason to suppose that any mechanism that could enhance well-being couldn’t also do the opposite – suggests it’s a toggle-able system…hmmm….
so. . . I think we can do some experiments.
We’ll use homeopathy advocates and animal rights loonies, to avoid ethical problems.
Ha! And we have to have lots of crystals. No crystals, no deal.
The cry of structural biochemists everywhere. . .
Who are we going to use for negative controls? Ben Goldacre, perhaps.