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MODERN MEDICINES
 SCIENCE & TECHNOLOGY IN FOCUS

MODERN
MEDICINES
The Discovery and Development
of Healing Drugs

Margery Facklam,
Howard Facklam, and
Sean M. Grady
 MODERN MEDICINES: The Discovery and Development of Healing Drugs

Copyright © 2004 by Margery Facklam, Howard Facklam, and Facts On File

This is a new edition of HEALING DRUGS: The History of Pharmacology

Copyright © 1992 by Margery Facklam and Howard Facklam

All rights reserved. No part of this book may be reproduced or utilized in any form or by
any means, electronic or mechanical, including photocopying, recording, or by any
information storage or retrieval systems, without permission in writing from the
publisher. For information contact:

Facts On File, Inc.

132 West 31st Street
New York NY 10001

Library of Congress Cataloging-in-Publication Data

Facklam, Margery.
Modern medicines : the discovery and development of healing drugs /
Margery Facklam, Howard Facklam, and Sean M. Grady.
p. cm.—(Science and technology in focus)
Includes bibliographical references and index.
ISBN 0-8160-4706-5 (hc.)
1. Pharmacology—History. 2. Pharmacology. I. Facklam, Howard. II. Grady,
Sean M., 1965–III. Title. IV. Science & technology in focus
RM41.F33 2003
615′.1′09—dc21 2003011489

Facts On File books are available at special discounts when purchased in bulk quantities
for businesses, associations, institutions, or sales promotions. Please call our Special
Sales Department in New York at (212) 967-8800 or (800) 322-8755.

You can find Facts On File on the World Wide Web at http://www.factsonfile.com

Text design by Erika K. Arroyo

Cover design by Nora Wertz
Illustrations by Sholto Ainslie

Printed in the United States of America

MP Hermitage 10 9 8 7 6 5 4 3 2 1

This book is printed on acid-free paper.

 CONTENTS
Acknowledgments ix
Introduction x

PART 1: SUPPLEMENTING THE IMMUNE SYSTEM

1 Ancient Remedies 1
The Iceman’s First Aid Kit 2
Physicians and Poultices 5
Health through Harmony 7

2 A Garden of Simples 11
Backyard Pharmacies and Old Monks’ Cures 12
The Apothecary’s Art 14
Treatments of Dubious Value 17

3 Patent Cures and Medicine Shows 23

Medicine Meets Marketing 25
Snake Oil Salesmen Hit the Road 28
Best-Guess Prescriptions 31

4 Formalizing Pharmacology 34
Classrooms and Battlefields 35
 Developing a Targeted Pharmacopoeia 37
Regulations for the Remedy Makers 42

PART 2: MODERN “MATERIA MEDICA”

5 A World of Wonder Drugs 47
Infections in the Trenches 50
Sulfa Drugs and Penicillin 52
Antibiotics from the Jet Age to the Millennium 55
6 Preemptive Strikes 58
Seeking Paths around Illness and Pain 58
Vaccination 60
Anesthesia 66
7 Biological Systems Management 68
Running on Empty 69
Hormones as Drugs 71
Fine-tuning the Brain 78
8 Miracles in the Medicine Cabinet 81
Prescribing Your Own Pills 81
Sneezes and Fevers 83
Pain and Swelling 85
Dieting and Diarrhea 86

PART 3: ON THE MARKET

9 From the Laboratory to the Pharmacy 91
Running the Regulatory Gauntlet 92
Drug Testing 97
Generic and Orphan Drugs 99
A Case in Point: The Response to HIV/AIDS 100
10 Producing Modern Pills and Potions 102
Pharmaceutical Assembly Lines 103
Hatching Vaccines and Milking Bacteria 105
Keeping Things Pure 108

11 New Uses for Old Drugs 111

Aspirin: From Headaches to Heart Attacks 112
Going beyond the Design Specs 114
Searching for Beneficial Side Effects 116

12 When Drugs Go Wrong 119

The Thalidomide Years 120
Dangerous Interactions 122
Drug Allergies 124
Expired Medications 125

PART 4: ALTERNATIVE TREATMENTS

13 Back to the Garden? 129
Searching the Jungles for Cancer Cures 130
Herbs, Vitamins, and Mineral Pills 132
Pharmaceutical Foods 135

14 Herbalists and Scientists 136

Echinacea and the Common Cold 138
Proving Herbs Work 141
A Pharmaceutical Look at Herbs 143

15 Warning Signs 145

An Herb Clashes with a Drug 146
Dangerous Interactions Revisited 149
Quality Control 151
PART 5: RESISTANCE MOVEMENTS
16 Drug-Resistant Germs 157
Trouble in the Hospital 157
Old Enemies Return 160
Giving Drugs a Rest 163

17 The Perils of Medicine 166

The Do-It-Yourself Pharmacist 168
Dangerous Dosages 169
Prescription-Drug Addiction 171

18 Distribution Woes 173

The Flu Vaccine Shortage of Y2K 174
Supply and Demand 176
Production Problems 178

19 Future Trends in Pharmacology 181

Clues from the Genome 182
Old Enemies Become Unlikely Allies 186
Who Will Make Our Drugs? 188

Appendixes
Glossary 193
Further Reading 211
World Wide Web Sites 215

Index 219
 ACKNOWLEDGMENTS
The authors wish to thank all those who provided information and
photographs for Modern Medicines, the revised edition of the 1992 book
Healing Drugs: The History of Pharmacology. In particular, they wish to
thank Lisa Bayne of the Eli Lilly and Company archives; Pat Virgil and
Linda Kennedy of the Buffalo & Erie County Historical Society; and
John Swann of the U.S. Food and Drug Administration.
Special thanks also to Frank K. Darmstadt, Executive Editor, and
Cynthia Yazbek, Associate Editor, for their forbearance with its
preparation.

ix
 INTRODUCTION
Whether through great epidemics such as the Black Death that killed
more than one-quarter of the population of Europe—roughly 40 mil-
lion people—in the 14th century or through infections of wounds as
simple as the scratch from a rosebush, disease has been a constant com-
panion of humanity.
While all but a rare few of us are born with immune systems that
adequately protect against many diseases, our immune systems often fail
to withstand the assault by bacteria, viruses, molds, parasites, and other
microscopic threats called pathogens that are around and within us all
the time. At these times, we can turn to modern medicine: antibiotics to
fight off bacteria, fungi, and even some forms of cancer; painkillers such
as aspirin and ibuprofen, which also help fight fever and inflammation;
antihistamines that short-circuit the symptoms of hay fever and other
allergies. Using these and other healing drugs has helped many people
gain the upper hand over disease and has freed them from much of the
fear and helplessness they might feel when confronted with disease.
In the past, death from illness was a common part of life. Childhood
was an especially dangerous time, when germs easily could overwhelm
a boy’s or a girl’s still-developing immune system. Many children died
before reaching their teen years, though adulthood did not guarantee
freedom from illness. Old age was equally dangerous, leaving men and
women as vulnerable to death from infections as their grandchildren.
One of the most upsetting aspects of disease was the lack of an eas-
ily identified cause. Few people knew, or even suspected, that micro-
scopic organisms were to blame for disease until nearly the end of the
19th century. Noxious gases, imbalances in a person’s body fluids, eat-
ing the wrong type of food at the wrong time of year, witchcraft—these
were the explanations common folk and professional healers came up
with to explain the outbreak of illness.
x
 Introduction xi

The remedies they relied on also varied widely—using herbs and

other plants, taking part in healing rituals, wearing talismans that sup-
posedly had the power to turn away evil spirits of disease. Some were,
from a modern perspective, truly absurd. One treatment given to a
European king in the Middle Ages was a concoction of crushed pearls
and gemstones mixed in a goblet of wine. Drinking the mixture was
supposed to infuse the patient with the “magical powers” of the gems.
In truth, the only likely effect the potion had was to give the royal
patient a stomachache.
Other remedies, though, turned out to have true medical benefits.
Scientific examination of an ancient European remedy for headaches,
tea made from the bark of a willow tree, led to the discovery of aspirin.
Likewise, investigating a cure for malaria used by Indians in the moun-
tains of Peru—the powdered bark of the cinchona tree—resulted in the
discovery of quinine, an effective fever medicine as well as a reliable
means of treating the disease.
Nevertheless, diseases of all sorts caused devastation around the
globe until well into the 20th century. For example, a worldwide out-
break, or pandemic, of the Spanish flu in 1918 and 1919 killed so many
people that their numbers are still disputed to this day. Conservative
figures from the early 1920s indicated a total of 21 million deaths.
More recent estimates place the toll near 40 million—four times as
many deaths as had been caused during the four years of World War I,
which ended shortly after the first signs of the pandemic appeared.
With the discovery that bacteria, viruses, and other pathogens
caused diseases came a revolution in the way diseases were studied and
treated. Events such as the Spanish flu pandemic prompted medical
researchers to find new ways to attack these invisible invaders within
the human body. Penicillin, tetracycline, and other antibiotics came
about as the result of this research. At the same time, researchers began
expanding upon the technique of vaccination, which was developed in
the 18th century by an English physician as a means of combating
smallpox. The widespread eradication of polio, a crippling disease that
can leave its victims partially paralyzed, and the virtual elimination of
smallpox from the world are just two of the technique’s most astound-
ing successes.
These and other medical developments, together with the demand
for the drugs that have been created, made the medical drug industry
the richest single sector of the modern global economy. More than
telecommunications, computers, or even agriculture, pharmaceuticals
(the collective term for medical drugs) are in such high demand that
large, established firms and small start-ups alike are in constant full-
xii Modern Medicines

throttle competition to bring new drugs to market. Many nations have

developed an intricate—and, some manufacturers and physicians say,
overbearing—system of regulations to qualify drugs for use and to
remove drugs that turn out to cause more harm than good.
The development of modern pharmaceuticals has not been a sim-
ple matter, though. Many times over the 20th century, a promising and
seemingly safe drug turned out to have disastrous side effects that were
not discovered during its development. In one of the most infamous
cases of a side effect discovered too late, the drug thalidomide, which
had been prescribed to pregnant women in the early 1960s as an anti-
nausea remedy, caused horrible birth defects in the patients’ children.
A potentially more dangerous, and certainly more ironic, effect of
the success of pharmaceuticals is a rise in the 1990s of viruses and bac-
teria that are immune to the drugs designed to fight them. Though the
effect of drug resistance has always been a factor in drug development,
until recently the human race has been able to keep a step ahead in its
quest to produce antibiotics and vaccines faster than the pathogens can
fight back. The appearance of so-called superbugs may be an indica-
tion that, at least in some cases, researchers have reached the limit of
what they can do in the laboratory.
Outside the laboratory, however, there are a multitude of plants and
other materials in the natural world—the original source of
humankind’s healing drugs—which may provide the new cures the
human race will need.
The following 19 chapters reveal how people discovered and devel-
oped the medicinal drugs in use today, describe how many of the most
common drugs on the market do their work, show how new drugs are
developed, and examine potential threats to human health and poten-
tial sources of future pharmaceuticals.
 PART 1
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