This article was first published in The Montreal Gazette.
There is no question that Linus Pauling was an eminent chemist, given that “eminence” is defined as fame or recognized superiority within a particular sphere or profession. In this case, chemistry.
Pauling was a Nobel laureate, published an incredible 1,200 papers and books, including a textbook on chemical bonding used by students around the world. He was also my introduction to the difference between eminence-based and evidence-based science. Opinions or advice that come from a scientist or physician with an established and often stellar reputation but lacking evidence can be termed “eminence-based.” This is in contrast to “evidence-based” science that is backed by proper studies. In in the case of health matters, those are ideally randomized, placebo-controlled trials (RCTs).
Pauling was a champion of supporting his theories of chemical bonding and molecular structure with evidence drawn from X-ray crystallography. He was a hair away from scooping James Watson and Francis Crick on the structure of DNA.
Curiously, in 1970, this eminent scientist who had published hundreds of peer-reviewed articles in the world’s leading scientific journals penned a book claiming that the common cold can be cured with large doses of Vitamin C. Incredibly, he offered no evidence other than his own and his wife’s personal experience. But since Pauling was widely acclaimed as one of the world’s leading scientists, the press jumped on the Vitamin C story and supplements of the vitamin flew off the shelves. Evidence had been trumped by eminence.
While Pauling’s diversion into eminence-based health advice was surprising, the fact is that until the 20th century, when RCTs began to emerge, medicine since the time of Hippocrates was essentially eminence-based. Hippocrates owes his fame not to introducing effective cures, but to pioneering the idea that diseases have a natural cause and were not doled out by the gods as punishment. However, he wrongly attributed the cause to an imbalance of four body fluids, or “humours”: blood, phlegm, yellow bile and black bile. Treatments to restore balance included hot and cold baths, purgative herbs and bloodletting. He did recommend cutting back on food to “starve a fever,” but there is no evidence of Hippocrates ever uttering “let food be thy medicine,” a quote often attributed to him.
Following in Hippocrates’ footsteps, Galen of Pergamon furthered the notion that diseases have physical causes and searched for these by carrying out vivisections, experiments on live animals. He made detailed drawings of anatomy, but they contained many errors, since dissections of humans were not allowed in ancient Greece or Rome. Galen did gain some insight into human anatomy by examining the wounds of gladiators, but he did not understand the circulatory system, believing that blood was produced in the liver and delivered to tissues where it was dissipated. Galen’s eminence was such that his views would hold sway for 15 centuries until, William Harvey published his classic work On the Motion of the Heart and Blood in Animals in 1628.
The idea that illness is the result of a humoral imbalance persisted until the advent of the germ theory in the 1850s. Until then, eminent physicians like Benjamin Rush, a signatory of the U.S. Declaration of Independence, were recommending calomel (mercury oxide) or syrup of ipecac for purging, and bloodletting was a treatment for almost every ailment. U.S. president George Washington’s death was precipitated by his physicians repeatedly bleeding him.
Eminence did not always lead to such brutal methods.
John Harvey Kellogg achieved fame by claiming to cure people of various illnesses with vegetarian diets, exercise, baths and yogurt. He was a showman par excellence, famously regaling patients at his sanitarium in Battle Creek, Mi., with an “experiment” that involved tossing a steak and a banana at a chimp. The ape ignored the steak and happily ate the banana as Kellogg intoned that even this primitive creature knows that meat is not for consumption. Kellogg believed that eating meat was “sexually inflammatory” and maintained that people who ate bacon for breakfast were doomed to masturbate, an activity that would lead to rotting of the brain and insanity.
Corn Flakes, according to him, were the anti-aphrodisiacal breakfast food.
In Rational Hydrotherapy, a 1,217-page book he published in 1900, Kellogg claimed that every known ailment can be helped by the application of cold, hot or tepid water. He described how streams of water directed at various parts of the body were curative and that the soles of the feet are connected by nerves to the bowels, genitals and brain. There was no evidence for any of this, but Kellogg was an eminent physician, so his claims were not challenged.
Kellogg’s treatments were a cakewalk compared with those of Dr. Walter Freeman, who exemplifies another case of patients placing their faith in eminence instead of evidence.
Freeman graduated from Medical School at the University of Pennsylvania and later earned a PhD in neuropathology. He came to believe that mental illness is amenable to surgical treatment and invented the “transorbital lobotomy,” a procedure that involved penetrating the brain with an ice-pick-like instrument through the eye socket to sever the connection of the frontal lobes to the hypothalamus.
Freeman had no evidence that the procedure was an effective treatment for mental illness, but incredibly managed to perform about 4,000 lobotomies before he was barred from carrying out the procedure because of the frightening rate of complications.
Freeman’s eminence was in large part due to having lobotomized Rosemary Kennedy, sister of the future U.S. President John F. Kennedy. Rosemary’s erratic mood swings, learning difficulties and aggressive behaviour were deemed unsuitable for a Kennedy by her father, the unsavoury Joseph P. Kennedy. He had her lobotomized by Freeman. She ended up unable to walk or speak properly and spent the rest of her life in institutions.
Luigi Di Bella also carried out lobotomies, albeit metaphorically. He rose to eminence in Italy in 1997 after triggering collective hysteria in cancer patients with his claim that a combination of the hormone somatostatin, vitamins, retinoids, melatonin and bromocriptine, a Parkinson’s disease medication, can cure cancer. Di Bella was a legitimate physician, but with an illegitimate claim.
His basic ploy was, “trust me, I’m an eminent physician.” When oncologists claimed that Di Bella had no evidence, they were accused of conspiring to keep cancer patients from a potentially curative therapy. Demonstrators clamoured for “freedom of treatment” and threatened to bring down the government. Officials caved, clinical trials were organized, and the results sent the Di Bella regimen to the junk heap of medicine. Eminence lost out to evidence.
Today we have a whole new breed of physicians whose eminence is due more to their media exposure than their accomplishments. The likes of Mehmet Oz, Deepak Chopra, Steven Gundry, Joseph Mercola and Christiane Northrup have become mega-influencers and continually use their eminence to upset the evidence-loaded cart.
As for Linus Pauling, he has received a small measure of vindication from a meta-analysis that showed a reduction in the severity of a cold with large doses of vitamin C. When I feel a cold coming on, I have found that taking a gram an hour for four hours can often ward it off. But take that with a grain of salt, because I have neither evidence nor eminence.
