My Rabbit Hole: History of Wonder Drugs

How did doctors of 800 AD predict the death of a patient? They wiped the sick person with a lump of lard and then threw it to a dog in an unfamiliar neighborhood (or an unfamiliar dog). If the dog ate the lard, then the person would survive.

Bizarre, unfounded yet very common practice back in the hay day. Aside from being humorous and silly, this story raises an important question.

Have doctors always been the altruistic messiahs of mankind that we are led to believe or is there evidence suggesting otherwise?

Ancient Chinese and Indian medicine regarded mercury as the miracle drug, an elixir to promote health and cure nearly every disease: to treat inflammation in the nose and throat; corneal stains; ulcers and warts; against diarrhoea and vomiting; for liver and lung diseases and most notably, against syphilis. The physicians of the first emperor of unified China, Qin Shi Huang, prescribed mercury pills promising him an eternal life. Concerns that the prescription was having ill effects on the emperor’s health and sanity were waved off by the imperial physicians, who cited to medical texts listing a number of the emperor’s conditions (including itching, formication, swelling, and muscle weakness), today recognized as signs and symptoms of mercury poisoning, as evidence that the elixir was effectively treating the emperor’s latent ailments. Now we know better and consider mercury intoxication as a life-threatening emergency.

Women were not spared from the ignorance of medieval physicians either. European prescriptions for abortion included a paste of crushed ants, the saliva of camels and tail hears of black-tailed deer dissolved in the fat of bears. Pennyroyal oil — known to cause syncope, seizures, coma, cardiopulmonary collapse, acute liver injury, renal insufficiency and multiorgan failure — was prescribed to abort the fetus. Little did the physicians acknowledge that the medication would abort the life of the woman as well.

One may argue, that medieval physicians were trying their best with whatever few resources and research they had at hand. However, reckless prescriptions and capitalism were a disease plaguing doctors of the 19th and 20th century as well.

Morphine, cocaine and heroin were standard first-line therapy for a wide range of diseases. They were marketed as the treatment for everything under the sun — toothaches, depression, sinusitis, lethargy, headaches and sleeplessness. In their enthusiasm, it was also prescribed to teething children suffering from cough and cold. In 1902, there were an estimated 200,000 cocaine addicts in the United States alone.

Prevention medicine wasn’t spared either. Diet pills had been the growing trend since 1880s but the big bad wolf in sheep disguise was Fen-Phen (appetite suppressant Fenfluramine and amphetamine Phenteramine) from the 1990s. Dr. Weintraub apparently performed a single study with mere 121 patients showing no adverse events caused by the drugs. What was left ignored that the drug caused severe heart valve abnormalities. Fen-Phen became so popular that nearly 6 million Americans were hooked onto it. The Food and Drug Administration approved the drug in 1996 but then had to retract their approval due to the truth finally coming to light.

Is the situation the same today? Thankfully, not.

Doctors are now increasingly relying on evidence-based medicine, and drug approvals are only granted after years and multiple levels of rigorous, controlled clinical trials. The safety profile of the drug being prescribed is of utmost concern to the doctors and the disadvantages of polypharmacy are gaining increasing traction. However, it would be too early to begin the congratulatory party.

A lot of work is yet to be done.

Mental health is one such field requiring attention. There has been a sharp increase in the prescription of anti-depressants and anti-psychotics to children and adolescents around the world, as first line therapy, despite limited efficacy. Most of the behavioral issues observed in children of their age group can be easily addressed by cognitive behavioral therapy and psychoeducation yet most practitioners choose the road plagued with adverse events and roadblocks. Similarly, chemotherapy and immunotherapy used in patients with metastatic patients are mostly experimentation at the level of clinical trials, serving little to reduced benefit to the patients, themselves. How many patients will continue to be the victims of the limits of our knowledge?

In light of our history, it is safe to say that Voltaire, the French satirist, wasn’t joking when he said “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”