Five drugs that changed the world and what went wrong
It is difficult to measure the impact of a drug on the history of the world. But here are five drugs that we can safely say have made a huge difference in our lives, often in ways we never expected. They brought amazing benefits. But they usually come with a legacy of complications that we need to critically examine.
It’s a good reminder that today’s miracle drug may be tomorrow’s problem drug.
In the late 1700s, the English chemist Joseph Priestley made a gas he called “phlogisticated nitrous air” (nitrous oxide). English chemist Humphry Davy thought it could be used as an analgesic in surgery, but instead became a recreational drug.
It was not until 1834 that we took a new step. It was then that the French chemist Jean-Baptiste Dumas named a new gas chloroform. Scottish physician James Young Simpson used it in 1847 to assist in childbirth.
Soon anesthesia was more widely used during surgery, bringing better recovery rates. Before anesthesia, surgical patients would often die of pain shock. But any drug that can knock people unconscious can also cause harm. Modern anesthetics are still dangerous due to the risks of suppressing the nervous system.
What happened to Scottish physician Alexander Fleming in 1928 is one of the classic stories of accidental drug discovery. Fleming went on vacation, leaving cultures of the strep bacteria on his lab bench. When he returned, he saw that airborne penicillium (a fungal contaminant) had prevented strep from growing.
Australian pathologist Howard Florey and his team stabilized penicillin and performed the first human experiments. With American funding, penicillin was mass-produced and changed the course of World War II. It has been used to process thousands of service personnel.
Penicillin and its descendants are extremely effective first-line drugs for diseases that once killed millions of people. However, their widespread use has led to drug-resistant strains of bacteria.
Nitroglycerin was invented in 1847 and replaced gunpowder as the most powerful explosive in the world. It was also the first modern drug to treat angina, the chest pain associated with heart disease.
Factory workers exposed to the explosive began to experience headaches and facial flushing. This is because nitroglycerin is a vasodilator – it dilates (opens) blood vessels. London doctor William Murrell experimented with nitroglycerin on himself and tried it on his angina patients. They got almost immediate relief.
Nitroglycerin has helped millions of people with angina live relatively normal lives. It also paved the way for drugs such as antihypertensives, beta-blockers and statins. These drugs have prolonged life and increased the average lifespan in Western countries.
But because people’s lives are now being extended, death rates from cancer and other non-communicable diseases are now higher. Thus, nitroglycerin turned out to be an unexpectedly world-changing drug.
4) The pill
In 1951, American birth control advocate Margaret Sanger asked researcher Gregory Pincus to develop an effective hormonal contraceptive, funded by heiress Katharine McCormick.
Pincus discovered that progesterone helped stop ovulation and used it to develop a trial pill. Clinical trials have been conducted on vulnerable women, notably in Puerto Rico, where there were concerns about informed consent and side effects.
The new drug was marketed by GD Searle & Co as Enovid in 1960, with US Food and Drug Administration approval. This was granted because the risk of pregnancy was considered greater than the risk of side effects, such as blood clots and stroke.
It took ten years to prove a link between the use of oral contraceptives and serious side effects. After a US government investigation in 1970, the pill’s hormone levels were significantly reduced. Another result was the patient information sheet that you will now find inside all prescription medicine packets.
The pill caused major global demographic changes with smaller families and increased incomes as women re-entered the workforce. However, it still raises questions about how the medical profession has experimented with women’s bodies.
The first benzodiazepine, a type of nervous system depressant, was created in 1955 and marketed by the pharmaceutical company Hoffmann-La Roche under the name Librium. This drug and related drugs were not sold as “cures” for anxiety. Instead, they were supposed to help people engage in psychotherapy, seen as the real solution.
Polish-American chemist Leo Sternbach and his research group chemically modified Librium in 1959, producing a much more potent drug. It was diazepam, marketed from 1963 under the name Valium.
Cheap and readily available drugs like these have had a huge impact. From 1969 to 1982, Valium was the top-selling pharmaceutical product in the United States. These drugs created a culture of managing stress and anxiety with medication.
Valium paved the way for modern antidepressants. It was harder (but not impossible) to overdose with these new drugs, and they had fewer side effects. The first SSRI, or selective serotonin reuptake inhibitor, was fluoxetine, marketed from 1987 under the name Prozac.
Philippa Martyr, Lecturer, Pharmacology, Women’s Health, School of Biomedical Sciences, University of Western Australia
August 18, 2022