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Article[5] The "Tomato effect,"
as described by Dr. James Goodwin. Dr. James Goodwin spoke to the 7th International Symposium on Functional Medicine about the "Tomato Effect," the tendency for academic medicine to reject certain effective therapies because they do not fit into the current theories in place.
Dr. Goodwin is chief of Geriatrics at University of Texas at Galveston.
In 1984, he and his wife Jean Goodwin published the landmark paper "The
Tomato Effect," in the Journal of the American Medical Association 1984;
251:2387-2390.
Dr. Goodwin introduces the subject by describing how, when the
tomato was discovered in the New World, it was brought back to Europe, and it
was grown as an ornamental plant, the "love apple." For several
hundred years the Italians ate the tomatoes, but in Northern Europe and in North
America it was not eaten at all, because "everyone knew" that it was
poison. Finally, in 1820, after Edward Gibbon at a tomato in the courthouse
steps in Salem, N.J., and he did not die, people started to eat tomatoes.
Dr. Goodwin draws a parallel with medical treatments and the
tomato. He tells the history of the use of colchicine and aspirin, and
describes the attitude of modern medicine toward vitamin supplements.
Colchicine is an extract from the Autumn Crocus plant, colchicum,
that has been commonly used for gout. It was used consistently by the
upper classes and nobility (who got gout more often than the peasants due to
consumption of meat and alcohol and from water pipes.) from the 7th century
until the 13th century. It was very effective for this very painful
condition, and it was also known to be toxic in large doses. It was also
used then as a purgative according to Galenic and Hippocratic theories, since it
gave diarrhea in large doses. Islamic physicians also used it for gout.
Why then did colchicine drop out of use in the 13th century?
Renaissance medicine went back to the classic theories just like the arts at
that time. Medicine then held that disease was caused by an imbalance of
humors, (not too different from Chinese Traditional Medicine), and treatments
focused on ways to balance the humors. It did not include extracts from
plants and potions, which were considered witchcraft. Those were the times
when thousands of people were being burned alive for supposedly being witches.
Herbs were not a part of academic medicine. Gout was treated by bleeding
and by raising blisters.
Colchicine was rediscovered by Baron Von Stork in 1763, and was
included in his patent medicine L'eau du Sang, among other ingredients.
The King of England and the King of France used it regularly, but the medical
community did not accept it, and the Parisian physicians banned the Baron from
Paris. In 1830, the famous French writer Trousseau stated that colchicine
was bad and that it did not work. Colchicine came into general use not by
way of the medical community.
Aspirin and salicylates had a similar history in their use in
rheumatoid arthritis. In the 1870's and 1880's, controlled trials reported
in major medical journals such as JAMA and the Lancet showed the
effectiveness of high dose salicylates in treating rheumatoid arthritis.
At first they were derived from Willow bark, but later synthesized, salicylates
in 1870, and aspirin in 1880.
How then were the salicylates totally rejected by academic
medicine in the early 20th century? The germ theory was coming into vogue,
and rheumatoid arthritis was then considered to be a infectious disease.
They were totally rejected by Sir William Osler's textbook of medicine in 1910,
and by 1930, there was no mention of salicylates in the medical textbooks in
regard to rheumatoid arthritis. Cecil, in writing his first textbook
of medicine in 1929, asked the opinion of 16 arthritis experts, and none of them
mentioned any drug. let alone aspirin, in the treatment of arthritis.
It was 1957 before the salicylates began again to be used by
standard medicine for this condition. For several decades before, it was
not accepted because it did not fit the theory of the disease.
The resistance of American academic medicine to the concept that
micronutrient supplementation might have health benefits was discussed by James
Goodwin and his colleague Michael Tangum in Archives of Internal Medicine 1998;
158:2187-2191. Linus Pauling was excoriated by the medical community for
his work on Vitamin C. He was an outsider, and he published books for the
lay press, much like Galeleo who was beheaded for publishing his writings about
the world being round and revolving around the sun. Copernicus years
before said the same thing except he wrote it in Latin that only the academics
would read.
Dr. Goodwin reviewed dominant textbooks of academic
internal medicine from 1948 to 1995 and found that the quotations were not
just skeptical of vitamin supplements, but selectively skeptical and showing
obvious emotion, standing out from the usual boring style of writing.
Harrison's early edition of his Textbook of Medicine in 1950 -
"The present custom of massive vitamin supplementation on the part of the
American public may lead to carelessness in the selection of foods with
resultant amino acid or mineral deficiency. Failure to understand these
principles has resulted in much useless supplementation of patients with a great
variety of preparations containing vitamins. False reliance on vitamin
therapy has sometimes resulted in delayed institution of effective
therapies."
Cecil's textbook of medicine in 1960 states, "In a
normal diet, supplements are not necessary. The use of preparations
containing not only vitamins but several minerals is poor medical
practice."
Harrison's textbook in 1970 states, "Multivitamin therapies
are readily available. Physicians may be tempted to prescribe them because
they are thought to be harmless or because the looks upon this as a simple way
to protect patients from the small chance that they may develop deficiency
states. This practice is undesirable in 3 counts: 1. It is wasteful.
2. Unnecessary medicine is to be deplored. 3 It may lull doctors
into neglecting needed studies. There is no justification for the
widespread marketing of multiple vitamins for families for their purported value
pf preventing colds or infection. This effect cannot be documented.
The tendency among food merchants to increase the vitamin content of breakfast
cereals to therapeutic levels (Total? -my insertion) is an insidious marketing
device that cannot be justified." This paragraph obviously has an
angry tone, unusual to find in medical textbooks about other subjects.
Dr. Goodwin goes on to explain that nutrient supplementation has
not fit in to the current paradigm of medicine which sees disease as an active
agent that needs to be combated, not a condition in which a deficiency or
imbalance occurs. Common terminology currently includes
"fighting....disease." Therapeutic modalities are often
considered weapons against disease, and are commonly spoken of as "part of
your armamentarium." So disease as caused by a deficiency, (negative
causality) is an alien concept.
Dr. Goodwin concludes with a warning that anyone is susceptible
to this faulty type of thinking, not just conventional medicine. Many
things in alternative medicine are promoted because of a theory about how it
works. He says that health care practitioners, doctors especially should
not pretend to be scientists, should not use a particular therapy because they
think it does such and such.
The only tests of whether to use a treatment should be used or
not, according to Dr. Goodwin, is 1. Does it work? 2. Is it
toxic? 3. How much does it cost?
David G. Schwartz, M.D.
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