Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine
Author: Thomas Hager
Before a drug can change the world, it must be discovered. Ten Drugs tells stories of these fateful discoveries. Taken together, they paint a picture of humanity’s long and complicated relationship with drugs. We often hear polarized views about “big pharma”, so this historical context about the pharmaceutical world is very relevant. Author Thomas Hager provides that context in an entertaining package. Below are some highlights I think worthy of remembering.
Opium & Friend
Humanity has had a long relationship with opium and it’s the source, the poppy plant. I mean a really long relationship — since 3,400 BC. The ancient Sumerians called the poppy “the joy plant.” As with most things ancient, people created customs around the special poppy plant, it’s processing and its usage. It spread from place to place over the years, too, eventually making its way throughout the known world via the Silk Road. Centuries of trial and error led to various processing methods, potencies, and preparations. In addition to opium, the Papaver somniferum gave us morphine and codeine as well as derivatives like heroin, Vicodin, oxycodone, and more. It’s really the workhorse of pain-killer drugs. All, unfortunately, suffer from extreme addictiveness. Scientists have long attempted to discover a drug that has the benefits of pain-killing without the addictiveness but to no avail. The current US opiate crisis is an echo of prior crises in the UK, China, and even the Civil War era US. It’s a useful example of history rhyming, as Mark Twain once quipped.
Variolation, Inoculation, Vaccination
I almost never think about smallpox. That’s great news because long ago it defined lives and eras even more powerfully than COVID-19 defines ours. Hager tells the story of Lady Mary Montagu, an English aristocrat born in 1689. In her time, smallpox outbreaks were both common and unstoppable. The best practice during an outbreak was to pack up and leave town because there was no effective treatment. Her brother died of smallpox in 1713, and she contracted the disease in 1715. She luckily survived the virus, though her face was forever pox-scarred. When her husband became Ambassador to Turkey, she joined him on the trip abroad. She noted a curious absence of pox scars on the locals and soon learned of the custom of variolation (aka inoculation). Practitioners would take live virus from a mild case and infect a healthy person via deep arm scratches. Once recovered, the patient would have lasting immunity. Determined to prevent her son from suffering the same fate as her brother, she had him inoculated under the watch of the embassy surgeon shortly before their recall to London. This proved effective protection, and at the start of the next outbreak in London, she had her daughter inoculated. This time, she invited an audience that included the Princess of Wales, mother of the heir to the throne. The inoculation practice spread among high society, largely protecting them from smallpox outbreaks, but with some serious safety risks. Almost 80 years later, Edward Jenner found cowpox afforded similar protection from smallpox with a significantly lower safety risk. In fact, vaccination takes its name from the Latin vacca — cow.
I thought penicillin was the first antibiotic, but the story of Sulfa predates it. If you watch World War II movies, you’ll sometimes see medics using white powder on open wounds. That’s sulfa. Researchers searched for a “magic bullet” that would kill a microorganism but leave its host unaltered. Unlike penicillin’s accidental discovery, the researchers were searching specifically for an antibacterial drug. Arsphenamine became the first Sulfa drug, used to fight syphilis infections. This success led to the search for more magic bullets, significantly increasing the funding for drug discovery research.
Historically, we locked the mentally ill away in asylums without much prospect for treatment. The best-in-class treatment was electroconvulsive (shock) therapy. While a French pharmaceutical company searched for new antihistamines, they accidentally discovered the first drug that could help psychiatric patients. However, they didn’t realize its value at the time. A couple years after its discovery, a surgeon used the compound on his patients to prevent death from surgical shock. Eventually, clinical trials at the asylum Sainte-Anne Hospital in Paris demonstrated a remarkable ability to improve the well-being of psychiatric patients. Until this discovery, the world’s asylums grew in population and expense with no end in sight. Chlorpromazine, the first antipsychotic, led to the entire mental health care drug market.
Birth Control Pill
The concept of a birth control drug came from the knowledge that women couldn’t get pregnant while they were already pregnant. Researchers learned that during pregnancy, women secreted progesterone, a hormone that blocked further pregnancy. They figured that giving women progesterone might enable them to avoid pregnancy. They tried to find a good source of the hormone, but it proved extremely hard to extract. Somebody found that a Central American Yam made loads of progesterone, then figured out how to extract and commercialize it. The other interesting story is the pill’s journey into the US market. Katharine McCormick, then the richest woman in the world, funded its development with $2 million — worth around $20 million today. When it was finally ready, they submitted for FDA approval for menstrual disorders rather than contraception to circumvent the restrictive Comstock laws against birth control.
High levels of cholesterol are associated with cardiovascular disease, heart disease, and other health conditions. Statins, a class of drugs, are amazingly able to lower cholesterol and its associated health risks with few side-effects. Statins work by blocking an enzyme in the liver that’s upstream of cholesterol production. It’s a life-saving tool for those at high risk of heart disease. Nowadays, it’s being prescribed much more widely for those who are only at moderate risk. During this part of the book, the author takes a long detour to share his personal experience with his health system pitching him statins without a doctor’s involvement. He continues with a long discussion of the US healthcare industry’s incentives to overprescribe.
Seven of the top ten best-selling drugs in 2018 were monoclonal antibodies (mAbs). Researchers figured out how to fuse specific cells that produce an antibody with cancerous myeloma cells. Each pair becomes a biological drug factory that pumps out a single specific antigen. mAbs are now some of humanity’s most powerful anti-inflammatory and anti-cancer drugs.
Ten Drugs covers each of these stories in detail, as well as some others I haven’t touched on. Anyone with an interest in the history of medicine can learn a lot from the book.