to wit, an Inarguably Wise but Jaded Forensic Psychiatrist Expatiating on Topics Medico-Legal, Historical, and Scientific, with a Few Non-Sequiturs for Good Measure
My cousin, the Air Canada flight attendant, periodically contributes to this blog. She wrote a post on Venetian Carnevale last Spring, which can be read at this link:
http://alienistscompendium.com/?p=1228
Now, here’s another installment from one of her recent layovers in Italy:
“It is a well-known stereotype – with more than a small kernel of fact – that Italian men drive like lunatics. Nothing that I have seen has lessened that impression. The streets in Florence are clogged with a mixture of ‘regular’ cars (Fiats), Smart cars (those adorable little two seaters), Vespas and other scooters, motorcycles, public buses, street-sweepers, odd three-wheeled contraptions called Crickets, and bicycles. Lots and lots of bicycles. Everything is weaving and darting in amongst the pedestrians crossing the streets and not paying attention to where they are going. The mixture entropically flows in all directions, and yet I have seen only two wrecks: a bicycle-pedestrian collision on my first trip here in which both parties were tourists not acclimated to the chaos, and a bus-Fiat impact yesterday, in which the two vehicles smacked and yet never stopped (many cars in town have huge dents from passing collisions just like this one).
Despite this potentially deadly pandemonium, the locals don’t seem to do anything to improve the situation, and in many ways appear to relish the traffic cyclone, revel in it, and even magnify it. Case in point: this afternoon, I was window shopping along a typically clogged road, and a bicycle passed me with a basket on the front. The rider, wearing a delivery uniform, was going at a good clip, dodging in and out of the crowd and avoiding obstacles as they appeared in front of him. I watched as he zoomed past me. He neared a small trattoria ahead, and he slowed slightly and yelled something in Italian at the door. Then he started pedaling like a fiend, laughing uproariously. I wasn’t quite sure at first what he had yelled or what had caused the furious pedaling afterward, but then a very angry appearing Jack Russell terrier came ripping out of the door, teeth bared, snarling furiously, and took off after the two-wheeled interloper.
don’t come around here no more!
Apparently this was a longstanding ‘feud’ and the delivery guy knew that the dog would chase him. The rider was pedaling even faster and yelling at the dog as he looked over his shoulder. Of course, the mad mixture of traffic and pedestrians was parting like the Red Sea, with those in harm’s way jumping to avoid the onslaught. The chase lasted for a full city block, and then, by precedent I suppose, the dog reached the stop sign at the end of the block, past which the bicycle had blasted just milliseconds before, snarled one last snarl, and turned and trotted back to the trattoria. The “audience,” which had just dodged these two Bats out of Hell, applauded heartily up and down the street (I think for the dog, not the delivery guy). The amazing thing was not even the chase itself, but the fact that in the traffic mess, no one was hit or injured!”
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to wit, a middle-aged peripatetic shrink undertakes the Great American Cross-Country Road Trip with help from little leaguers, German bikers, the King of Rock ‘n Roll, porn stars and an abandoned brothel, a flock of domesticated ducks, the Department of Homeland Security and the West Memphis police, a decommissioned atomic warhead, some dodgy motels… and a strange rider in the back of a 2013 Ford Fusion.
I confess that I can’t tell the difference between a $10 bottle of Shiraz and one costing $40. Likewise, I ordered a pricey steak dinner of Kobe beef when I was in NYC a while back, and I didn’t think it was any better than a good filet from the local grocery store in North Carolina. Many times it seems that you pay for the ambience, the name, the perceived status, and not the product itself.
This is not the case with motels. Trust me.
Normally I love visiting New Mexico, but Boney and I were getting tired, and after seeing The Thing, it was dark and I just wanted to reach our overnight accommodations. Not knowing how many miles I’d cover in any given day, I hadn’t made reservations in advance. Looking at the map, I decided to traverse the Land of Enchantment and make it at least as far as the eastern ‘burbs of El Paso TX before calling it a day.
Setting the cruise control on legal-max-plus-8, we crossed into New Mexico on I-40 near Lordsburg and continued for 170 miles. We approached El Paso after 10:00 p.m., but I still wanted to reach the far side of that dirty urban sprawl before stopping. Skirting just yards from the border, the glow of Ciudad Juarez visible to my right, we proceeded until my eyes became too heavy to continue.
The lights of El Paso were far behind. It was dark ahead. But the sign at Clint TX read “Adobe Inn this exit.” That would be it.
If you look up “Adobe Inn” on Orbitz, you’ll see that it gets 4.6 stars out of 5. Words such as “romantic,” “quaint,” and “charming” are used liberally throughout the reviews. Too bad that’s the Adobe Inn in Carmel CA.
The Adobe Inn in Clint TX has no Orbitz page. However, it does have a Yahoo! Travel profile; there is no picture posted, which is probably for the better. And there is even one Yahoo! review! A fellow named Ray wrote of it in 2009, “we found [the Adobe Inn] after running away from a very scary La Quinta in El Paso. This place… looks like an old design from the 60’s…. Our only complaint was the fuzzy blanket seemed to have someone’s hair stuck in it…. We removed the blanket and used our own quilt. Also, the mattress cover kept slipping around under us and we had to remove it. Unfortunately we ended up with very noisy neighbors out front.”
make your reservations for the Holidays now!
‘Someone’s hair’?! ‘Mattress slippage’?! ‘Noisy neighbors’?! And I’d hate to have seen that La Quinta.
But I didn’t have access to the Internet that night, so I pulled up in the parking lot of the Adobe, right next to Cotton Eyed Joe’s Saloon – which also should have been a warning. “It’s okay,” I thought. “I’m only here to sleep for a few hours, and I hate paying big prices for hit-and-run motel stops.”
The Adobe consists of twenty one rooms in two buildings flanking a large partially paved lot, populated on one side with what appears to be abandoned dumpsters. The few rattletrap cars and pick-up trucks parked in front of the guests’ doors were all ‘facing out,’ and I found myself wondering if that were to obscure the rear license plates, or perhaps for hasty middle-of-the-night departures? I pulled up to the small reception hut and went to enter. With apologies to Motel 6, no light was left on for me, and there were no signs of life inside – only the neon ‘vacancy’ announcement. Though it wasn’t yet 11:00 p.m., guests were instructed by a taped paper to “ring bell for service.” I rang twice. Soon a short Hispanic lady appeared, examined me through the glass for what seemed like a long time, and then buzzed me in.
Inside I found a small vestibule and an internal wall and window, on the far side of which was located the reception desk. As I approached the window, I noted that 1. the window’s glass was thick and staggered (so one can’t reach through) and looked to be bullet-proof, similar in appearance to what one sees in bank lobbies, 2. the door to the back room in which was located the desk was braced by a heavy chair from the inside, and 3. next to the window were cards for a local bail bond service, and a large hand printed sign that read, “no unregistered visitors, por favor.”
I asked her for a room. I didn’t inquire if the rates were per hour.
She spoke little, and I wasn’t sure of her command of English. But she knew the drill, and handed over a room key for a mere $49, including tax. I was beginning to regret my parsimony. As I opened my wallet to fetch cash, she caught sight of my DPS badge, and her facial expression changed, though to one of relief or concern I am still not certain.
Inside my room a few minutes later, I encountered Spartan décor that was mid-century Salvation Army at best. The furnishings were identical to what I had seen hours earlier at The Thing. The carpet was stained, the bedspread looked dingy, and the place smelled of stale cigarettes, all of which made the sign over the commode which read, “sanitized for your protection” seem laughable. A single towel and bar of soap graced the area around the sink. A small refrigerator in the corner was making horrible chugging noises which didn’t stop even after I unplugged the cord from the wall (!) And a fist-sized hole in the drywall completed the ambience.
I carried Boney inside. “No doubt he is not the first dead body to spend the night here,” I thought.
Taking a cue from the innkeeper, I braced the door from the inside with the sole chair. I also removed the nasty bedspread and pillow, employing instead my rolled-up pants for a pillow. But by this time I was too tired to care about much else.
At some point during the night I was semi-conscious of red flashing lights in the parking lot. I just rolled over.
Come morning, a few freshly scattered beer bottles rested near the dumpsters. All of the cars and trucks had left. I was alone in the parking lot. It was quiet. Really quiet.
I loaded my calcified friend in the back seat and dropped my key in the slot up front. There were still no signs of life inside the reception area. The ‘vacancy’ sign was still on. We headed for the interstate, foregoing breakfast at Cotton Eyed Joe’s, were it even open.
[to be continued…]
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Francis Crick (1916-2004) was a brilliant molecular biologist, biophysicist, and neuroscientist who was co-awarded a Nobel Prize in Medicine for discovering and describing the structure of the DNA molecule.
Crick
In 1955, senior British government ministers had proposed that a science and technology-based school be established within the University of Cambridge in England. This seat of learning, to be named in honor of Winston Churchill, was to admit students to pursue undergraduate and graduate degrees in all subjects except theology.
Churchill
On this basis, in 1960, Crick accepted a fellowship at the newly founded (all-male) Churchill College. Before long, though, a sizeable donation was made to the College by Lord Beaumont of Whitley for the building of a non-denominational chapel on the grounds. A majority of the fellows voted in favor of it. Crick the lifelong atheist was incensed at what he saw as the intrusion of mythology into a facility dedicated wholly to rational scientific thought.
Winston Churchill, in an attempt to avoid a very public spat over this controversy, wrote a letter to Crick in which he said that many at the College would “appreciate” a place to worship nearby. The chapel was to be entirely funded through private monies, and would be located on the edge of campus, as opposed to its heart. The chapel further would be open to men of all faiths and backgrounds, and no one would be forced or expected to enter it against their will.
Crick replied to Churchill on 12 October 1961 with a counter-suggestion that many at the College would “appreciate” a brothel nearby. Said bawdy-house could also be funded entirely through private monies and located on the edge of campus. The brothel would be open to men of all backgrounds, and no one would be forced or expected to enter it against their will. His letter to the former Prime Minister included a personal cheque for £10 as the first contribution toward that end.
The chapel was constructed. Crick resigned from the College shortly thereafter in protest. It is said that the two men never spoke again.
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Putting the descriptors “16 year old male,” “new driver,” and “parallel parking” in a sentence together almost never bodes well.
However, in my case, they came together for an interesting life experience.
In 1978, I was a high school sophomore, new drivers license in hand, and living with my parents in a condo in Arlington VA. The DC subway line was in the basement of our building, and given the complex’s proximity to National Airport, the Pentagon, and Foggy Bottom and other points downtown, many government workers inhabited the area.
Parking was assigned in the underground levels of our condo, and by luck and the arrangement of the concrete support pillars, our designated parking spot and one other spot shared a small sliver of the garage to themselves. The car parked next to ours was a brand new Oldsmobile Toronado. At first, I didn’t know to whom this car belonged, but over time I saw a distinguished older gentleman getting in or out of the Olds, and we began acknowledging each other and waving.
My father owned a 1975 Cadillac Eldorado behemoth at the time. While I was a careful driver and never had an accident with it, I suppose the sight of a 16 year old high school sophomore trying to parallel park that supertanker would make most other drivers give a wide berth. The man next to whom we parked, sensing that his car might be in danger, several times stood behind me to provide unsolicited directions to help me with the process of gliding the Caddy into the space between his car and the concrete support pillars. There was never a scratch, and over time, we began to chat when we met in the garage.
Senator Talmadge
It was only then that I learned that the man was former-Governor and then-U.S. Senator Herman E. Talmadge (D-Ga), scion of a powerful Southern political family. And before long, talking while parking cars, he had offered me a job in his Capitol Hill office.
I’ve already blogged about this a bit at:
http://alienistscompendium.com/?p=587
I was the only non-Georgian working as an intern in the office that summer. I never did tell anyone how I had come to be offered the position. And while I didn’t perform duties that were very high-powered – filing, opening and sorting mail, delivering papers to other Senate offices – I did learn two important life lessons that have remained with me to this day.
#1. Don’t assume that the ball won’t come your way, and be prepared if it does. One of the perks of laboring on Capitol Hill was being invited to play in the after-work softball league. This wasn’t a very serious group of athletes. All the office staffers, Democrats and Republicans alike, plus the occasional lobbyist, met on the grounds around the Washington Monument when the weather was nice. Apparently the Capitol Police looked the other way re: public drinking, because everyone back then had a beer in one hand and their mitt on the other. And I witnessed more than once some usually buttoned-down staffer, having changed into shorts and a t-shirt, getting clocked by a stray ball while making no effort to deflect or catch it… for fear of dropping or spilling the beer in hand. One must have priorities.
#2. Don’t assume that the messy sandwich won’t come back to bite you when you’re on a date. I don’t even remember her name, but there was a female intern in the Senator’s office to whom I took an immediate liking. Perhaps it was the Georgia accent? After a while I asked her out to lunch. Capitol Hill has many bistros and cafes that serve the midday office population; they tend to be upscale, as much venues in which to see and be seen as to receive sustenance. For odd reasons known only to a foolish teenager, once she and I were seated in the brass-and-mahogany tap room, I decided that the hot meatball sub with parmesan cheese would the best item to order for lunch. To add to the idiocy of this decision, I decided to use my hands to eat it rather than silverware. After two bites, the entire melted-and-tomato-sauce’d contents wound up in my lap after having first run down the length of my starched white shirt and silk tie. Oddly, she was ‘busy’ for lunch every time I asked after that, but I have never again ordered messy foods on dates.
As for Senator Talmadge, my inside track to recurring Capitol Hill employment ended late the following year when he was censured by the full Senate for “improper financial conduct,” all starting when his angry estranged wife reported finding more than $43,000 in mystery cash in a raincoat in their hall closet. The censure contributed to the Senator’s loss in the next general election. His car vanished from the downstairs parking deck shortly thereafter and I sadly never saw him again.
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My maternal grandfather, James Gilbert Gove, was born in 1884 and raised in the tiny English village of Appley in Somerset. He was a stonemason by trade, and in 1913, age 29, he found himself working jobs on nearby estates and trying to support a wife and growing family.
I suspect he needed money. He joined the local militia, much as people do today when enlisting in the National Guard to earn extra income and educational opportunities, and gain some camaraderie.
The Goves, ca 1914
I mean, it’s not like there was a war ongoing at the time or anything.
Mysteriously to his descendants – he had no musical training of which anyone knows – there is an extant photo of him with his unit, a territorial battalion of the Devonshire Regiment, holding a tuba. He seems to have been assigned to the regimental band.
Gove and his tuba, back row, far right
Then in August 1914, the Great War erupted.
Granddad caught wind that his unit was preparing to ship out… to the far reaches of the Empire. To India.
Apparently he didn’t want to go to the other side of the globe.
It was then that he learned that the Royal Engineers were recruiting in the area. Given his building experience and training as a stonemason, he correctly surmised that they might want his services.
He transferred from the Devonshire Regiment to the 505th field company of the Royal Engineers, and promptly left for France.
France was going to be better, right? It’s a whole lot closer than India.
In later years, Granddad spoke little of his life serving in the trenches and defensive earthen fortifications in Flanders. But he did say that there were times in which he was speaking to fellow soldiers standing just a few yards away… as they had their heads blown off by shrapnel or snipers.
And of his former unit, the territorial battalions of the Devonshire Regiment? The majority did indeed ship out to Karachi, Basra, and Lahore, there to spend the duration of the war in arguably less dire straits, far from the mechanized killing fields of the Somme and Ypres.
Yes, Granddad did survive, none the worse for wear. But his is a story to remind you to be careful for what you wish….
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Sleep difficulties are a common complaint in the population at large and especially amongst psychiatric patients. Unfortunately, the drugs that are readily used to address insomnia are not candy. Many of them can be habit forming, are expensive, produce their own set of undesirable side effects, and can alter deep sleep morphology – producing a less-than-rested sensation upon awakening. There were times in the past when patients of mine would exhibit resistance to every suggestion for healthy sleep practices (e.g., no coffee or soda, moderate exercise, cool bedroom temperatures) and would insist on Rx. These weren’t necessarily people who were abusing drugs… they were just convinced of the all-encompassing Power of Rx to cure their perceived ills, and no amount of redirection seemed to work.
Enter the placebo.
Much has been written about the ethics of dispensing placebo, but I’m convinced that in the right place and at the right time, it is a useful and humane option. Back in the early 1990s as a resident, for select inpatients, a large brightly colored capsule at bedtime – the colors were always blindingly neon, suggesting power far beyond drab greys and whites – produced the subjective perception of sedation and deep restorative slumber, absent both side effects and habituation. Those patients wanted sleep. I gave them an inert intervention that helped them feel better. A true win-win.
“How,” the reader will ask, “did you explain this intervention to the patients without boldfacedly lying to them?” Easy… by telling the truth in ways that were not immediately obvious. One of the main ingredients in the placebo capsules was stearic acid, a type of benign filler and preservative also found in some hard candy. I would tell patients, honestly, that I wanted to give them a capsule containing stearate “because in many cases it has been found to assist patients with problems just like yours.” That is a wholly truthful statement, and yet the patient interpreted the words in the way they wanted to interpret them.
The days of using placebos are over as far as I can tell. This is because patients are constantly reading online, and liability surrounding informed consent has become too risky. Had I used the ‘stearate is good for people with problems just like yours’ line recently, the patients or their families would have looked up the substance on their iPads and then come back to complain that what I was giving them was nothing more than an inert filler.
But the passing of the Age of Placebo is not necessarily a bad thing, albeit with one caveat.
Too many patients who visit physicians in general, and psychiatrists in particular, view the awarding of a Rx script as a validation of sorts. To visit a shrink and not come away with a pill is perceived by many as having failed in the therapeutic interaction. Faced with taking time and trying to educate patients about proper Rx usage and then having them go away miffed, many doctors will prescribe a consolation prize – antidepressants, anxiolytics, sleep aids, you name it. Yet those consolations are not risk-free, and render us a nation of unnecessary pill-poppers.
It was for these situations that placebos often made sense. In their absence I trust that my fellow physicians will just learn to say ‘no’ more often.
The Placebo Effect is very real, especially when employed for issues with high degrees of subjectivity, such as pain and sleep. If a patient is fragile and already taking (arguably) too much Rx, does a physician give yet another (potentially addictive) Rx that may interact with all of the other Rx… or try an inert sugar pill that could yield relief and cause no harm whatsoever in the long run? Ethicists will debate this endlessly, but I know from my own experiences as a resident in the 1980s that I favor the latter approach in carefully selected cases.
The placebos we could order from the pharmacy back then were HUGE capsules in bright neon colors. They looked powerful. To amuse ourselves when on-call and nothing was pressing, we’d make up names for them. My clinical supervisor at the time labeled his as ‘Obecalp,’ which is ‘Placebo’ backwards. I always preferred ‘Fallacine’ or ‘Fauxene’ for mine. And this is actually how the pharmacy would dispense them when a patient was discharged: “Fauxene one tablet Q6hrs as needed,” and then in parentheses “Stearic Acid” (the generic name of the inert filler/ preservative in the sugar pills).
More times than not, inpatients would greet me at the ward door the next morning – or outpatients would come to our next meeting – and report how soundly they had slept or how their pain seemed much more manageable.
[sidebar: once a patient called me after discharge to say he’d run out of Rx before his upcoming outpatient appointment, asking if I’d refill. Normally I didn’t write Rx for discharged patients, but I asked him what it was that he needed. He replied, “P-L-A-C-E-B-O.” The pharmacy had apparently mislabeled the container. I gladly refilled]
But here’s the really amazing thing: the Placebo Effect doesn’t necessarily rely on ignorance on the part of the patient! Research has shown – repeatedly – that the Placebo Effect still exerts benefit, even when patients KNOW they’re taking placebo!
Case in point: a recent study at Duke University (Ariely et al.) gathered 82 people and gave electric shocks to their wrists. Then, the cohort was divided in half, and each of the test subjects was given one of two pills, shocked again, and asked to compare the pain initially with the pain after taking their respective pill. Of the first group, 85% said the pill reduced the pain. On the other hand, only 61% of the second group said that the pill reduced the pain. Whichever pill the researchers gave their “patients” worked, though the first pill clearly worked better.
It shouldn’t surprise you that some of these test subjects received placebos. What might be surprising, though, is that in this study, ALL of the test subjects received placebos. On top of that, both groups received the exact same thing: sugar pills of identical size, shape, color, &c. So why did the first group feel less pain than the second group?
Apparently it was due to the price. The second group was told that their pills were being sold at a huge discount.
Specifically, as the New York Times reported in 2008
the first group was informed that their pills cost $2.50 each. The second group, though, was told that their pills typically sold for $2.50, but the price had been cut dramatically – all the way to ten cents each. Other than that, the two groups went through the same process, the same electrodes, the same pills, the same everything. But news of the discounted price seemingly rattled some of the subjects’ faith in the pills’ quality, and, therefore, reduced the Placebo Effect!
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[originally posted by the Alienist in early 2012, but worth reexamining]
Last evening, I was reading a periodical before bed, and as I thumbed absent-mindedly through the pages, several large advertisements from pharmaceutical companies caught my eye – Pristiq (antidepressant), Aricept (anti-dementia), and Abilify (antipsychotic sometimes used to augment antidepressant) amongst them.
As a physician, these encounters wouldn’t be unusual… except that I was glancing through Psychology Today, a lay publication written specifically for a mass audience of non-clinicians. And it certainly doesn’t stop there – one only needs to pick up (mostly ladies’) print media to find all manner of colorful Direct-to-Consumer (DTC) drug ads splashed across the pages.
The rise of the Internet, and the explosion of available educational resources via both print and digital outlets, has been a boon in innumerable arenas, not the least of which is health education. But it is a double-edged sword. My heart leaps for joy when a patient arrives for an appointment carrying sheaves of drug print-outs courtesy of self-serve Wikipedia. Undoing mis-information, or mis-interpreted accurate information, takes much longer than just explaining the pertinents from scratch.
I confess that I harbor more than a bit of residual paternalism, and I realized a long time ago that I’m too late to the world of psychiatry (as I would like to see it practiced). But heck, I went to medical school for four years, residency for four years, passed my boards, recertified, and now have logged over two decades of clinical experience. I think I’ve learned a few things along the way re: how to take good care of patients, only to have my job made all the more difficult by the presence of freely available op-ed pieces and data of dubious quality ‘out there.’
The Rx problems in my profession seemingly began with fluoxetine. Most of you know it as Prozac, and it came on the market in the United States in 1988, the year I graduated from medical school. A tiny amount of DTC pharma advertising existed prior to Prozac – at least one branded form of ibuprofen as well as Pneumovax were hawked thus – but it wasn’t until the late 1980s that the world of psychotropic Rx was really impacted by Madison Avenue. Before Prozac, I suspect that if persons on the street had been asked to name an antidepressant, they would have had difficulty doing so unless a prescription had been written for them personally or for someone in their immediate family. But once Prozac hit the market and was pitched to the public, it became a household name (along, shortly thereafter, with all of its closely-related chemical brethren), discussed at length by armchair psychiatrists at water coolers, over PTA coffees, and in late night TV monologues.
The ads got glitzier, the people on the glossy pages looked happier, and anyone who wasn’t totally contented in life would be forgiven for thinking that the pill being marketed would make existence an endless summer afternoon garden party too.
Prozac ad (reprinted courtesy of MindFreedom.org)
With all of this unfiltered talk on the airwaves and in ink, it just added fuel to the fire of self-diagnosis and, in my opinion, drug seeking behaviors. The health professions in general, and Pharma in particular, are unfortunately responsible for the ever-increasing ‘A Pill Exists For Every Ill And Can Fix Anything’ school of thought.
Accordingly, as front-line clinicians, it is now our responsibility to do a better job explaining what Rx can and cannot do, regardless of what the paid models and cute little cartoon characters in the magazine ads might suggest.
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The ancient Romans would boil grape juice in lead pots to produce a sugar syrup concentrate called sapa. This syrup was used to sweeten wine and preserve fruit. It is likely that lead acetate leached into the sapa from the pots, causing lead poisoning in those who consumed it.
There are some well-known lead acetate casualties. Pope Clement II died in October 1047, and a toxicology examination of his remains conducted in the mid-20th century confirmed centuries-old rumors that he had been poisoned with lead sugar. In 1787, painter Albert Christoph Dies swallowed less than an ounce of lead acetate; his eventual neurological recovery was slow and incomplete. And though the use of lead acetate as a sweetener was already illegal at the time, Beethoven may have died of lead poisoning caused by wines accordingly adulterated.
In 1878, in rented lab space at Johns Hopkins University in Baltimore, a young chemist, Constantin Fahlberg, was running tests on compound purities and also attempting to develop coal tar derivatives – not particularly exciting work. One evening, after returning home to eat dinner – and apparently not washing his hands – Fahlberg noticed that the bread roll he had just chewed and swallowed tasted very sweet. After determining that the roll was not baked to be sweet, he came to the conclusion that some substance he spilled in the lab had remained on his hands, and was responsible for the taste.
He just didn’t know which of the day’s chemicals was responsible.
Fahlberg went back to the lab and started tasting residues (yuck). He eventually discovered the source of the sweetness: a beaker filled with sulfobenzoic acid, phosphorus chloride, and ammonia. This deadly sounding cocktail had boiled over earlier in the day, creating benzoic sulfinide.
Fahlberg quickly penned a paper describing the compound and the methods of creating it. Published in 1879, the paper listed both Fahlberg and another chemist in the lab, Ira Remsen, as the creators. However, in 1886, after realizing the compound’s massive commercial potential, Fahlberg changed his mind, patented the substance – which he called Saccharin – and listed himself as the sole creative mind behind it.
Thus was born the first seemingly safe, cheap, and artificial alternative to sugar sweeteners.
Saccharin, advertised as a non-fattening alternative to sugar, was fairly successful at first, though it wouldn’t be until the sugar shortages in WWI that it became a widespread hit.
The substance’s purported co-discoverer, Remsen, was by then the President of Johns Hopkins University; he often said of his former collaborator, “Fahlberg is a scoundrel. It nauseates me to hear my name mentioned in the same breath with his.”
Saccharin’s success almost was derailed in the 1970s, when several clinical studies – later shown to be flawed – alleged that it caused bladder cancer in lab rats and, by faulty extrapolation, in primates and humans. Even though the National Academy of Sciences published a meta-analysis in 1974 showing that Saccharin was harmless, the damage in the court of public opinion was widespread and entrenched; thus followed the federal Saccharin Study and Labeling Act of 1977, which didn’t ban the sweetener outright in the U.S., but required package labeling that read, “use of this product may be hazardous to your health, as this product contains Saccharin which has been determined to cause cancer in laboratory animals.”
It wasn’t until 2000 that Saccharin was removed from U.S. National Toxicology Program’s list of substances that cause cancer. The next year, both the state of California and the U.S. Food and Drug Administration removed it from their list of cancer causing agents. In 2010, the Environmental Protection Agency concurred, stating that “Saccharin is no longer considered a potential hazard to human health.”
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