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07/25/2002
Rx: Just a Tad of Poison
"The poison is in the dose." This profound statement was
brought to mind last week when I saw a news report on what
went wrong when some women opted for Botox injections at a
substantial discount to the going rate for the plastic surgery. One
woman''s body was shown covered with ugly scars, blisters and
infected lesions resulting from the injections. It turns out the
surgery was performed by "plastic surgeons" who were no such
thing. I didn''t catch whether or not the bogus practitioners used
real Botox.
The TV report reminded me of a brief article in the July 2002
issue of Discover magazine. The article, by Susan Freinkel, was
titled "New Remedies from Old Poisons" and contained the
quote I used to open this column. Freinkel attributed the quote to
the "Renaissance physician and apothecary" Paracelsus. I
thought to myself that Paracelsus was one cool dude to have
made that observation about dosage and poison way back in the
1500s. Botox is a prime example where the dosage makes the
difference between a poison and a therapeutic drug.
Even water can be dangerous in too large a dose. We''re
continually admonished to drink 8 glasses a day or equivalent of
the stuff. And on hot, sticky days like today (I had to quit after
nine holes), avoiding dehydration is a "good thing", as Martha
would say. However, in the Discover article Freinkel cited a
recent study of marathon runners who became deathly ill after
their races. The study found that the cause of their distress was
too much water. Because of the dilution of salt in their blood,
there was a buildup of fluid in their lungs and brain! Paracelsus
was right, dosage matters.
Back to Botox, the approval by the FDA of it''s use to treat frown
lines in April this year spurred a huge demand for injections from
the wrinkled masses. Botox works by inhibiting the release of a
compound known as acetylcholine, which signals muscles to
contract. Injection into the frown line muscles essentially
paralyzes them so they can''t contract and the frown is gone, if all
goes as expected. Yet, the botulinum toxin in Botox in doses
some 70 times higher could result in botulism and erase you
along with your frown lines! As for myself, I''m going to live
with all my wrinkles and sags.
Aside from such cosmetic uses, there are apparently other, more
pressing medical applications of Botox given in small-doses. In
addition to cerebral palsy, Parkinson''s, migraines and other
conditions, one that I found interesting was in treating what
might well have been called the Ed Sullivan disease. We all
watched Ed Sullivan in the early days of TV; you can still see his
syndicated shows on Public TV. Judging from the article, Ed
had what is known as cervical dystonia, a condition in which the
neck is frozen at an uncomfortable angle. In Sullivan''s case, his
rather odd posture was somewhat of a trademark and provided
material for comedy routines. Botox might have straightened up
poor Ed.
Arsenic and its compounds are well known poisons. In the play
"Arsenic and Old Lace", two lovable spinsters make a practice of
feeding arsenic-laced delicacies to unsuspecting men. In real
life, India has a huge problem with too much arsenic in the
drinking water in certain areas of that country. Here in the U.S.,
Christie Whitman and the EPA have been under fire by
environmentalists for not instituting stricter limits of the amount
of arsenic allowable in our own drinking water. If you ingest
arsenic in one big dose or repeated small doses, you''re likely to
experience the same fate those fellows in the play suffered at the
hands of those spinsters. Surprisingly, Freinkel cites the case of
some people in Austria who have claimed that arsenic has a tonic
effect. These adventurous souls built up such a tolerance for
arsenic that they could ingest repeated doses that would kill you
and me.
Along these lines, Freinkel cites the use of arsenic trioxide in
treating a lethal form of leukemia known as promyelocytic
leukemia. She cites a study of some 52 patients given a third of
the dose of arsenic trioxide that would kill them. Almost 90
percent of the patients went into remission and half were still
alive two years later. It seems that instead of killing cells as does
standard chemotherapy, the arsenic compound targets a protein
that stops white cells from normal development. It''s the
abnormal development of the white cells that results in leukemia.
Freinkel discusses other examples of Paracelsus'' truism. For
example, pure nicotine in doses as small a ten thousandth of an
ounce will put you six feet under. Yet patches of nicotine have
been used to treat maladies such as Tourette''s syndrome,
Alzheimer''s (I should hasten to add, it''s not a cure), attention
deficit disorder and even schizophrenia. Another example is the
venom from a type of cone snail that uses its venom to paralyze
passing fish. Injected into humans it''s much more potent than
morphine as a painkiller.
I wasn''t familiar with Paracelsus and decided to check him out a
bit further. I ended up consulting the International Encyclopedia
of Science and Technology", my Encarta 97 Encyclopedia, my
World Book Encyclopedia, a Catholic Encyclopedia Web site
(newadvent.org), a Rice University Web site and a site
(dbhs.wvusd.k12.ca.us) whose origin is unknown to me. Why all
these sources? I was simply trying to find out the guy''s name!
One source has the "Swiss physician" Paracelsus starting out life
in Switzerland in 1493 with the name Phillipus Aureolus
Theophrastus Bombastus von Hohenheim. (Other sources
describe him as a German. As best I can determine, Switzerland
as such was still in the process of being invented in the 1490s.)
Various sources have different versions of his name involving all
sorts of permutations and combinations of some or all of the
above names. No wonder he adopted the pseudonym of
Paracelsus. I''m only sorry that when I picked out my own
pseudonym I hadn''t read about him. The name Theophrastus
Bortrum would have been much more impressive!
One thing for sure, Paracelsus was a controversial character,
aside from his name. He seems to have offended just about
everyone he met. One source suggests that he either died in a
drunken stupor or was thrown down a flight of stairs by envious
apothecaries! Another source says that reports of his drinking
were untrue and that he died of natural causes, albeit he was only
48 years old when he died.
Why is Paracelsus important? He is generally given the credit
for altering the course of medicine. How? He not only
questioned the 1400 year old works of the Greek physician Galen
and the Arab Avicenna, he publicly burned their works to
express his disdain. For 500 years, Avicenna''s "The Canon of
Medicine" had been the standard medical text throughout the
Middle East and Europe. Paracelsus thought that disease was not
caused by imbalances in the body "humors", as was the
prevailing belief from Galen''s time in Greece. Paracelsus said
instead that disease arose from outside causes for which he
described remedies. For example, he prescribed mercury for the
treatment of syphilis and would prescribe "essences" and
"tinctures" for various maladies. Whether or not these remedies
worked, he seems to be the one we should credit for initiating the
the modern era of therapeutic measures to cure and prevent
disease.
Although Paracelsus is described as a physician, sources disagree
on whether or not he ever actually received a medical degree.
There''s no doubt that he was an alchemist. He considered the
body to be composed mostly of salt, sulfur and mercury and
introduced such things as mercury, lead and opium into the
pharmacist''s catalog of remedies. I perused one of his purported
writings on one of the cited Web sites. It was pure fantasy, with
weird, totally incomprehensible instructions for such things as
turning mercury into silver and gold and other alchemy.
Whatever his faults, Paracelsus shook up the medical
establishment of his time and paved the way for more wide
ranging studies of diseases, their causes and treatments. And
today, poison is even more truly in the dose.
Allen F. Bortrum
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