A Cultural and Scientific Tug of War

Throughout the history of medicine, there has been an intriguing interplay between pop culture and science. Two feature articles in this issue are emblematic of this dynamic. Our piece on medical marijuana highlights the duality of this field. On one hand, the discovery of cannabinoid receptors illustrates how exogenous natural and synthetic products can interact with our bodies and produce both wanted and unwanted biological effects. On the other hand, the push for medical marijuana was not so much driven by science, as the clinical studies to date are small and inconsistent, well below the threshold required for any drug to be approved by the FDA. Rather, the driving force was a declaration of the freedom that people have over their own bodies, especially when they are suffering from symptoms that they feel are best addressed by their own choice of medications. That is not to imply an absence of clinical benefit of the many compounds found in cannabis. There is, in fact, evidence that it can help with appetite, nausea, pain and neurological disorders such as refractory seizures. But without significant public and private funding, we will not have the high-level proof needed for mainstream adoption, despite the numerous states now legalizing its medical use.

Our article on pH balance and alkalinity is another example of folklore that could actually have a scientific basis. Cancer cells do exist in an acidic environment due to their high metabolism and restricted blood supply, but is this a cause or an effect? While our pH is tightly regulated, we may be able to control it at a regional level, or tweak it enough to have a biological effect. Even though there is not enough data to alter one’s lifestyle or diet solely for this purpose, research into cellular metabolism and the tumor microenvironment is growing at a rapid pace. This line of investigation has both diagnostic and therapeutic implications, but we are only scratching the surface. It would therefore be premature to completely sideline the notion of pH control — probably not by diet alone, but with other pharmacological (or possible natural product) means in the future.

The lesson to be learned from the cultural and scientific tug of war in medicine is that the two together may hasten our arrival to the truth of many matters. Remembering the many examples of ancient herbal remedies that form the basis of modern medicines, we should adopt a combination of open-mindedness (creativity) and skepticism (scientific rigor) — two ends of the spectrum that circle together to advance medicine, and much more.

DEBU TRIPATHY, MDEditor-in-ChiefProfessor of MedicineChair, Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer Center