REVIEWS AND VIEWS OF LIFE

Books of Interest
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“Ten Drugs” How Plants, Powders, and Pills Have Shaped the History of Medicine

By: Thomas Hager

Narrated By: Angelo Di Loreto

Thomas Hager (Author, science historian, editor, publisher, Oregon native, received master’s degree in medical microbiology and immunology from the Oregon Health Sciences University.)

“Ten Drugs” is a critical view of today’s drug industry, its drug discoverers, the medical profession, and its manufacturers. Hager explains opium is proven to have been used by Mesopotamian Sumerians in 3400 BCE but older than its known cultivation. The Sumerians called it “hul gil” which means “joy plant”.

Thomas Hager begins with opium and its discovery thousands of years ago when the bitter taste of a poppy seed capsule is tasted by a curious African’, Egyptian’, Greek’, or Roman’ Homo erectus.

Wide use grew to affect national relations between China and the western world in the opium wars of 1856-1860. China’s Qing dynasty lost territorial control of Hong Kong to Great Britain when opium became a cash cow for international trade.

Hager explains how opium offered both risk and reward to the world. It threatened society with addiction and overdose while offering surcease of pain for the wounded or health afflicted.

Addiction significantly increased among the Chinese during and after the opium wars. After many tries to prohibit opium, it was in the early 20th century that addiction was internationally condemned. It was the People’s Republic of China in 1949 that launched an aggressive anti-opium campaign that dramatically reduced opium purchase and use in China. Later, Hager infers China’s success in eliminating the trade is by murdering its dealers and penalizing its users. Ironically, Hager notes former President Trump called for the death penalty for drug dealers to combat America’s drug crises, a policy only likely to be implemented in an authoritarian country.

The first opium war in China, 1841.

Hager infers China’s success in eliminating the trade is by murdering its dealers and penalizing its users.

Hager explains the history of opium evolved into drug derivatives like morphine, laudanum, and codeine to offer pain relief from a variety of medical maladies. These derivatives were effective but still carried the risk of addiction. Hager explains later that addiction is related to nerve system receptors at a molecular level that create a craving for the effects of particular drugs. Opium and its derivatives eventually became regulated because of their addictive character. In America, the Harrison Narcotics Tax Act of 1914 marked the beginning of strict control of opium’s derivative prescriptions in the U.S.

Edward Jenner (1749-1823, English physician and scientist who discovered the use of cowpox to inoculate against smallpox.)

Hager moves on to vaccination. Interestingly, Hager explains the discoverer of inoculation by transfer is not Edward Jenner (1749-1823), a British physician called the Father of Immunology. It was a wealthy English woman named Lady Mary Worley Montague who learned of the use, of what became known as vaccination, in Turkey. She had survived a smallpox infection. Ms. Montague accompanied her husband, who was the British ambassador to the Ottoman empire in 1716.

Ms. Montague learned of a Turkish custom of transferring infected smallpox exudate to healthy children to give them a milder form of smallpox. That transferred exudate inoculated the young from getting a fatal dose of the disease in later life. Smallpox is estimated to have killed over 300,000,000 people (a statistic roughly equivalent to every person alive in the U.S. in the in the 1990s). The Turkish custom of inoculation was found highly effective.

Lady Mary Worley Montague who learned of the use of vaccination in Turkey. Earlier in her life, she had survived a smallpox infection.

In her return to England, Ms. Montague widely disseminated information about the success of the Turkish custom to prevent smallpox. Edward Jenner chose to use cowpox as a substitute tissue for smallpox vaccination of his patients. Jenner found cowpox infected tissue was equally effective in immunization and less dangerous than the using smallpox exudate. Jenner’s discovery of cowpox vaccination in 1796 became widely accepted but nearly 80 years after Ms. Montague’s worldwide promotion of Turkey’s vaccination procedure. Jenner’s vaccination success led to the World Health Organization’s claim that smallpox eradication could be achieved through an international inoculation program. Smallpox is alleged to have been eradicated as a disease in 1980.

The next drug identified as important by Hager is sulfa, a major cause of death from infected open wounds.

The common cause is a bacteria called Streptococcus. Bayer Corporation, a dye manufacturer in Germany, decides to enter the drug industry because their investment, facilities, and research scientists were ideal for entry into research and manufacture of drugs. They compound a drug called Prontosil that is discovered as a sulfa based chemical compound that successfully kills Streptococcal bacteria that cause fatal infections from open wounds. Bayer’s discovery saved many lives as WWII was gathering in the 1930s. Ironically, one of the saved lives is FDR’s son who had a severe streptococcal infection in 1936.

Hager notes personal mental illness and social dysfunction are perennial maladies that plague society through the 21st century.

Isolation and various therapies have been used to address mental illness. In early days, asylums were created to isolate patients who could not cope with daily life. Palliative treatment ranged from isolation to Freudian consultation, to electroshock, to newly discovered drug treatments. Though not mentioned by Hager, a little research shows the first significant breakthrough drug was lithium in 1949.

John Cade (1912-1980, An Australian psychiatrist discovered the effects of lithium carbonate as a mood stabilizer in 1948.)

Lithium was actually discovered in 1817 but did not get used for mental illness until 1948 when John Cade, an Australian psychiatrist, found that lithium carbonate stabilized mo0d and reduced the severity of manic episodes in patients.

Though Hager doesn’t mention lithium, he notes the French chemist Paul Charpentier identified antihistamine in 1950 as an antipsychotic to aid his patients’ erratic behavior. The use of Thorazine became a common drug synthesized by Rhone-Poulenc Laboratories in France. It was released in the 1950s and considered a major breakthrough in psychiatric treatment. It had a calming effect on severely schizophrenic patients by attacking excess dopamine production in the brain.

The major criticism Hager has of drug manufacturers and the medical industry is in the inherent influence of money, power, and prestige that distorts honest evaluation of drug effectiveness and side effects.

The drug industry depends on the success of their research for new drug discoveries to maintain the cost and improve the value of their businesses. However, human nature gets in the way of every human being. The lure of more money, power, and prestige enter into evaluative judgements and descriptions of tests for new drugs. The financial success of a drug that mitigates or cures particular societal ills make millions, if not billions, of dollars for drug manufacturers. Drug manufacturers are not eleemosynary institutions. They are in the business of making money and preserving their longevity while enriching themselves and their stockholders. Hager argues human nature distorts the truth of drug efficacy with tailored reports of a drug’s true benefit and potential for harm. He offers statins as an example of drug manufacturers’ misleading promotions.

Hager reviews the history of statins and correlations drawn by the medical industry about their efficacy in reducing heart ailments.

He suggests clinical studies by manufacturers often distort the entire effect of statins in preventing heart attacks. Statins are designed to reduce cholesterol in the blood stream. However, many studies that correlate cholesterol with heart disease are only partly related to heart attacks while having measurable side effects that diminish human cognition, memory, and potential organ damage, i.e, liver and kidney damage. Hager cautions those who take statins not to stop without discussing it with their physicians. However, Hager recounts an unsolicited personal contact that suggested he should be taking a statin because he is over 60 and had a brain vessel bleed in his earlier medical history. The contact recommended Hager take a statin based on that history. Hager notes that he felt his private medical history had been hacked, and that the contact is evidence of drug industry promotion of statins for profit more than public benefit.

In Hager’s last chapters, he explains how the drug industry is being attacked for influence peddling. In drug manufacturers drive for profits, they offer incentives to the medical profession (e.g. trips to conferences in exotic resorts, personal solicitations from sales reps, etc.) to use specific drugs in their practices.

In the end, Hager argues there are exceptions to the medical industries drive for profits by telling the story of British researchers Georges Kohler and Cesar Milstein who made a discovery in 1975 that changed the focus of drug manufacturer to what is called monoclonal antibody drug development. Kohler and Milstein found a process for creating drugs that have fewer side effects by creating antibody drugs that exclusively attack diseases at a molecular level. The irony of their discovery is Kohler and Milstein chose not to patent their discovery. If they had patented their discovery, they could have gained income for every company who chose to create monoclonal antibody drugs.

British researchers Georges Kohler and Cesar Milstein

Research is growing to create drugs that more precisely address the known molecular cause of disease without affecting the general health of patients. Not surprisingly, today’s manufacturers of monoclonal drugs use Kohler’s and Milstein’s process while requiring patents for their drugs.

Hager’s history of the drug industry illustrates the strength and weakness of human nature whether one is a capitalist, socialist, or communist.