Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine

251 Pages·2019·4.8 MB·English

by  Thomas Hager

Copyright © 2019 Thomas Hager Cover © 2019 Abrams
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CONTENTS
Introduction 50,000 Pills
CHAPTER 1 The Joy Plant
CHAPTER 2 Lady Mary’s Monster
CHAPTER 3 The Mickey Finn
CHAPTER 4 How to Soothe Your Cough with Heroin
CHAPTER 5 Magic Bullets
CHAPTER 6 The Least Explored Territory on the Planet
INTERLUDE THE GOLDEN AGE
CHAPTER 7 Sex, Drugs, and More Drugs
CHAPTER 8 The Enchanted Ring
CHAPTER 9 Statins: A Personal Story
CHAPTER 10 A Perfection of Blood
Epilogue The Future of Drugs
Source Notes
Bibliography
Index of Searchable Terms
INTRODUCTION
50,000 PILLS
On a business trip years ago, I had an extra day in London. So like many
tourists, I headed to the British Museum. And there I ran across something
extraordinary.
In a large, light-filled gallery on the ground floor was a table covered with
thousands of pills. It was an exhibit conceived by an artist and a doctor who had
come up with a way to display all the 14,000 doses of prescription drugs an
average Briton took in a lifetime. These pills, woven into lengths of fabric and
accompanied by bits of explanatory text, covered a gallery table that stretched
forty-six feet. I couldn’t believe what I was seeing. Did people really take this
many pills?
The answer is: No. They take more. The display was geared for Britain. And
when it comes to taking drugs, the British don’t come close to Americans. More
than half of all Americans take at least one prescription drug on a regular basis,
and most of those who fall into that group take more than one (somewhere
between four and twelve prescriptions per person per year, depending on which
study you look at). One expert estimates that Americans take an average of ten
pills per person per day. Add in nonprescription drugs—over-the-counter
vitamins, cold and flu remedies, aspirin, and other supplements—and run the
numbers: Let’s say a low-ball estimate of two pills per day per American over an
average seventy-eight-plus years of life. The total comes to somewhere more
than 50,000 pills, on average, in the average American’s lifetime. And there’s a
good chance it’s a lot more. America consumes more pharmaceuticals than any
other nation on earth, and we spend a lot more to get them: more than $34 billion
each year on over-the-counter drugs, and $270 billion on prescription drugs.
That’s way beyond what any other nation spends, because our drug prices are a
lot higher than any other nation’s. Americans constitute less than 5 percent of the
world population but spend more than 50 percent of the money that flows into
the world’s drug companies.
And that’s not even counting illegal drugs.
No nation in human history has taken as many drugs or spent as much money
to get them as the United States does today. And the drugs have had profound
effects. They have added decades to our average life spans, playing a central role
in the graying of America. Drugs have changed the social and professional
options of women. Drugs have altered the ways we view our minds, changed our
attitudes toward the law, shifted international relations, and triggered wars.
By these measures, perhaps we should rename our species Homo pharmacum,
the species that makes and takes drugs. We are the People of the Pill.
This book will introduce you to how we got here, with a focus on medical
(that is, legal, non-recreational, mostly prescription) drugs. It is written as a
series of brief, vivid sketches, sort of mini-biographies of ten drugs that changed
medical history, linked by common themes, with each story leading into the
next.
One of those common themes is the evolution of drugs. The word drug itself
comes from old French and Dutch terms for the barrels once used to keep herbs
dry. Pharmacists 150 years ago were in many ways like today’s herbalists,
extracting and compounding their medicines for the most part from jars of dried
plants. That gave doctors in the 1800s a couple-dozen somewhat effective
natural medicines to help their patients (along with hundreds of useless, often
alcohol-rich elixirs, poultices, and pills made and ballyhooed by local
pharmacists). Today we have ten-thousand-plus, ever-more-targeted,
increasingly powerful high-tech medicines that can treat and often cure
conditions that have confounded healers for thousands of years.
Wrapped in this evolution and guiding its trajectory is humanity’s search for
magic bullets, medicines that can unerringly seek out and destroy diseases in our
bodies without doing any harm to our health along the way. The goal has always
been to find medicines that are all-powerful, but without any risk. That is likely
an impossible goal. We haven’t yet found a perfect magic bullet. But we keep
inching closer.
Another thread that runs through these chapters tells a bit about the growth of
the industry that makes drugs—the trillion-dollar behemoth that critics have
dubbed “Big Pharma”—and changes in the ways we regulate that industry. For
instance, in the 1880s you could get just about any drug you wanted without a
prescription, over the counter, including mixtures laced with opium, cocaine, and
cannabis. Now you need a prescription for almost any powerful medicinal drug,
and even with a prescription you can’t buy narcotics like heroin (well, at least
not in the United States). Drugmakers before 1938 could put just about anything
they wanted on the market as long as it didn’t kill you, and they didn’t try to fool
you with false advertising. Today, prescription drugs have to be proven both safe
and effective before they can be sold. These laws governing our drugs evolved,
in sometimes surprising ways, along with the drugs themselves.
Our attitudes have changed, too. In the 1880s, most people considered the
right to self-medicate as something close to inalienable. It didn’t matter if a drug
was good for you or not, deciding whether to take it was your choice, not your
doctor’s. If you wanted to buy one of the many patent medicine horrors available
from local drugstores, anything from radioactive water for cancer to opium-
spiked syrups for insomnia, well, it was your body. Nobody had the right to tell
you otherwise.
Today that’s been turned on its head. Now physicians hold the keys (in the
form of their prescription pads) to getting most drugs. Today, when it comes to
taking our medicine, we pretty much do as we’re told.
Drugs changed the practice of medicine, too. In the 1880s, doctors were
family counselors good at diagnosing ailments and providing solace and advice
to relatives, but almost powerless to alter the course of killer diseases. Today,
physicians are able to work miracles of lifesaving that their brethren a century
ago could only dream of. They are also all too often overscheduled, data-stuffed
technocrats more comfortable reading lab reports than holding a patient’s hand.
During the past sixty years, the average life expectancy for Americans has
lengthened by two months each year—mostly because of drugs. Vaccines have
allowed us to completely conquer age-old enemies like smallpox (and we’re
closing in on polio). Prescription drugs, along with public health efforts, have
made our lives much longer and, in general, healthier.
Not that there aren’t also great risks. Drug overdoses, from both legal and
illegal sources, are killing around 64,000 people each year, an annual death toll
that exceeds all U.S. military deaths in all the years of the Vietnam War.
Here’s what drugs have done for us: In the bad old days, say two hundred
years ago, men lived twice as long, on average, as women (mostly because of the
dangers of childbearing and -birth). And everybody in general lived about half as
long as they do today. A lot of that was tied to death early in life. If babies made
it through the risks and traumas of childbirth, survived the epidemic diseases of
childhood—smallpox, measles, whooping cough, diphtheria, and more—and
made it to adulthood, they could be considered lucky. Because then they could
die of consumption, quinsy, cholera, erysipelas, gangrene, dropsy, syphilis,
scarlet fever, or any of a few dozen other diseases that we don’t hear much about
anymore. Today we die from heart disease and cancer, diseases of the middle-
aged and elderly. People in the old days didn’t worry too much about heart
disease or cancer because few people in the old days lived long enough to get
them. Thanks to drugs, a group of scientists recently wrote, “People have
different diseases, doctors hold different ideas about those diseases, and diseases
carry different meanings in society.”
As you’ll see in this book, vaccines and antibiotics moved us from being
helpless victims of epidemics to being able to fight them off. Combined with
more effective public health measures—cleaner drinking water, better sewage
systems, better hospitals—drugs moved us from fearing the diseases of
childhood to suffering the diseases of the old. That’s a tribute to medicine in
general, and to drugs in particular.
These are technological tools capable of changing our culture. But when you
think about them, drugs are even stranger than that. Today’s pharmaceuticals are
high-tech, developed in cutting-edge laboratories after investments of tens of
millions of dollars, but a kind of high-tech so intimate, so personal, that they
have to become part of you to do their work. You have to snort them, drink
them, ingest them, inject them, rub them into your skin, make them part of your
body. They dissolve inside you and race through your blood from muscle to
heart, liver to brain. Only then, when they are absorbed, when they have melted
into you and melded with you, does their power unfold. Then they can attach and
trigger, soothe and calm, destroy and protect, alter your consciousness, restore
your health. They can jack you up or chill you out. They can addict you, and
they can save your life.
What gives them this power? Are they animal, vegetable, or mineral? All of
the above. Are they good for you? Often. Are they dangerous? Always. Can they
perform miracles? They can. Can they enslave us? Some do.
So, ever-more powerful drugs, ever-more powerful physicians, ever-more
diseases conquered. Seen this way, the story of drugs looks like a triumphant
march of progress. But don’t be fooled: Much of the history of drugs, as you’ll
see, is rooted in error, accidents, and lucky breaks.
Writing this book has, however, also convinced me that good old-fashioned
progress plays a central role, too, if you define progress as the logical, rational
application of a growing number of tested facts. Each new drug tells us new
things about the body, and each new understanding of the body allows us to
make better drugs. When the system is working well, each new scientific finding
is criticized, tested and retested, amended if necessary, and then becomes part of
a global library of facts available to other scientists. It builds. This synergy
between drugmaking and basic science, this dance between lab and pill and
body, described in tens of thousands of scientific publications over the past three
centuries, is now speeding up in tempo and growing in intensity. It is truly
progressive. If we can hold our world together, we are on the brink of greater
things.
I’ll tell you what this book is not.
It is not a scholarly history of the pharmaceutical industry. It contains no
footnotes. It ignores—out of necessity, for brevity—many world-shaking drug
developments. You won’t find every important drug here. But you’ll find many
of the drugs that have shaped both medical history and today’s world. I hope
you’ll come away with a better understanding of this fascinating part of society.
It is not a book that will teach drug scientists anything very new, because it
was not written for drug scientists. Rather, this book is for people who know just
a little about drugs and want to learn more. It is aimed at the general reader, not
the specialist—although I hope specialists, too, might come away with some
interesting new stories to tell.
It is not a book that will make drug manufacturers happy. Or pro-pharma
lobbyists. Or anti-pharma activists. It is neither a screed about the evils of the
drug industry nor is it a song of praise for the wonders of science. I have no ax to
grind, no agenda to promote.
My hope simply is to entertain you and to introduce you to a new world—the
world of drug discovery—in a way that explains not only a lot about the history
of medicine, but also something about our lives today, from our relationship with
our doctors to the advertisements we see on TV, from the epidemic of opioid
abuse to the possibilities of personalized medicine. Drug companies make
incredible profits, and yet many of us can’t afford the drugs we need. This book
will get you thinking about why.
If there’s one overarching lesson I hope you come away with, it is this: No drug
is good. No drug is bad. Every drug is both.
Another way of saying that is that every effective drug, without exception,
also comes with potentially dangerous side effects. This can be easy to forget in
the first flush of enthusiasm when a new drug hits the market. Pushed by huge ad
campaigns and often buttressed by glowing media reports, newly released
blockbuster drugs enter what’s called the Seige cycle (named after Max Seige, a