Sunday, 3 June 2018

Tales of Pythagoras, Aristotle and Genghis Can’t: haven’t we bean here before?


One of the things I read about last week was of a 32-year old man who sadly died while on his way to his honeymoon. He had eaten his meal on the plane, and died soon after from what appears to have been an allergic reaction to broad beans.  Whilst I understand that it is possible to have an allergy to many things, I hadn’t realised that hundreds of millions of people worldwide are allergic to the humble broad bean. The allergy is caused by a genetic defect, resulting in a person lacking the enzyme G6PD (glucose 6 phosphate dehydrogenase). It’s an enzyme involved in many of our vital body processes, and in particular for maintaining the integrity of red blood cells. It is a hereditary disorder, common amongst those from Greece, Italy, Spain and the Middle East. Most people with this deficiency are men. 

The Greek mathematician and philosopher Pythagoras wouldn’t eat broad beans. His followers, Pythagoreans, lived communally and were vegetarians, but also avoided eating the bean also known as the ‘fava bean’. However, this was not because they understood the allergic properties of the bean, but because they believed broad beans were a supernatural symbol of death.  They also believed it was sinful to eat beans. In the context of the death of the man on the plane from eating broad beans, it was probably an astute belief to hold. The broad bean was first brought to Europe in 1492, and it was one the first cultivated crops in history. It was an important source of protein for many. 

Many years later Aristotle, (often considered the Father of Western Philosophy) thought that Pythagoreans avoided bean as a form of political protest against democracy. In those days coloured beans were used to cast votes in elections. Pythagoreans decried democracy in favour of oligarchy. And talking of which, I read a story last week of Genghis Can’t signing a ‘Right to Try Act’ for terminally ill patients. It was a kind of strange story, as there are already 40 or the 50 states in the US who have enacted such a bill. The bill gives those with a life shortening condition who are terminally ill the right to try experimental treatments not approved by the US government. Interestingly, although the bill is entitled right to try, it does not mandate the pharmaceutical industry to make unapproved drugs available to patients asking for them.   

This new bill protects doctors and pharmaceutical companies from any legal risks of allowing unapproved treatments unless they intentionally harm a patient.  For me that is the rub. All drugs have to go through a rigorous process of clinical trials. This is a process that can take many years, typically ten to 15 years. There are good reasons for this, and the prime one is not to do harm to others; which, as a nurse of many years’ experience, is a duty I hold very dear. Whilst I’ve accepted I have a duty to try and help those patients I care for, I also recognise that in doing so, I should avoid causing any harm to them. Not causing patients any harm has almost always outweighed my sense of duty to try and help. It’s a balance that most health care professionals face every day in practice.  

Our understanding of the underlying evidence and science underpinning most health care interventions is light years away from the Pythagoreans and their reasoning for avoiding broad beans. Allowing access to experimental and unapproved drugs not only means patients lose the protection of governmental approval, but also interrupt the process of developing new drugs and the establishment of an underpinning evidence base of ‘effectiveness versus harm’. This is why clinical trials are difficult to establish, run and successfully bring new drugs to the market. It’s a balance between protecting the many versus the exercising of choice by the individual. 

I feel blessed that I don’t live with a life-shortening condition. With very few exceptions, those people I have known with a terminal illness have all sadly died relatively soon after receiving their diagnosis. So of course I don’t know what decisions I might want to consider taking if I found myself in that position. That said, the news report made me stop and think about the ethical issues of allowing people access to unapproved drugs, however the desire to prolong life might be. I found the issue troubling. 

What I find less troubling is my love of ‘Phaseolus vulgaris’. That’s the posh name for haricot beans, from which most baked beans are made. I could eat them every day, on toast, with meals such as asparagus and pea risotto, or just cold out of the can. Pythagoras is probably turning in his grave! But there again he also said: ‘the square of the hypotenuse is equal to the sum of the squares of the other two sides’ – something drummed in to me as a schoolchild, but which is a piece of knowledge I have never felt the need to draw upon.