Half a Century Ago

August 22, 2024 by Doctor Vernon Coleman

The following essay is taken from `The Medicine Men’ (written 50 years ago and first published in 1975 but now available again as a paperback).

A decade or two ago, new and important drugs were being brought on to the market almost every year. Today genuinely original and exciting drugs are quite uncommon. Most of the new drugs made available are variations on a few basic themes. Drug company research is organised in a much more systematic way and research workers tend to produce drugs they want rather than simply to produce new drugs. The success of new drugs tends to depend on the marketing skills and on the amount of money available for promotional expenses. In the next few years a good deal of the research done is likely to be concentrated in four areas: drugs for the treatment of cancer, drugs for use in cardiovascular disorders, drugs with which to treat virus diseases and drugs for use in patients with psychological disorders. If we look at the problems facing researchers working in these fields we can see why there is less likely to be a sudden spectacular breakthrough with a single drug than there is to be a slow improvement in the variety of drugs available.

To begin with, take the highly emotive subject of cancer. There are many scores of cancer diseases and many different types of treatment available. Some cancers can be treated with drugs but others need to be treated with surgery or radiotherapy. Because different cancers often respond to entirely different types of drugs, a breakthrough in the treatment of one type of cancer (for example, a particular type of leukaemia) will not necessarily be of importance to researchers looking for a treatment for another type of cancer (even another type of leukaemia).

The most important drug we have which is used for the treatment of patients with cardiac disorders is probably still digitalis - the foxglove - which was first used medicinally several hundred years ago. Since the discovery of digitalis, hundreds of other useful drugs have been marketed and undoubtedly many more will be found in the coming years. These drugs will most probably be used in specific conditions when prescribed by specialist physicians. Whatever new drugs are produced, there is little doubt that more good could be done in this particular field by persuading people to diet, take exercise and stop smoking.

Drugs used to treat viral conditions are still very few and far between though several drug companies do make vaccines which are used to protect susceptible people from influenza. The problem when treating people with virus diseases is that there are many different types of virus and therefore many different types of drugs are needed. The companies making vaccines to protect us against influenza have found that they have to work very fast to produce a vaccine which can be used against the virus which happens to be causing the trouble at any one particular time. So, again, progress is likely to be slow and unspectacular.

In the field of psychotherapy there are already far too many drugs available. Anxiety and depression have been regarded as very fertile ground by the drug companies who have, to some extent, created a market, though the need has been exacerbated by the breakdown of the family unit, the inability of the family GP and others to provide psychological support and the willingness of patients themselves to accept pharmaceutical alternatives to spiritual support. Pills provide them with a substitute 24-hour-a-day physician. There are unlikely to be any major developments in the pharmaceutical treatment of psychological disorders until scientists have learned much more about the biochemistry of the nervous system. Even then advances will probably be slow if only because of the ethical problems which will ensue when physicians attempt to interfere actively with the metabolism of the brain.

There have been many claims made in recent years for drugs used in the treatment of major psychological disorders such as schizophrenia but doctors are beginning to query the real value of some of these drugs. Many of the drugs said to be effective have in fact created as many problems as they have solved. Patients have been enabled to go home but they have then presented a great problem to friends, relatives, employers and community health services. We should be cautious about exaggerating the values of new drugs for use in psychological disorders.

Researchers dealing with the problems of finding new drugs will have to bear several general points in mind. Firstly, they will have to remember that as Professor Rene Dubos has pointed out 'the more selective the activity of a drug, the better the chance that its toxicity will be minimal.' Drug toxicity is a problem which will be with us for some time. Bernard Towers, Professor of Paediatrics at the University of California wrote: 'It is pertinent to ask oneself whether a single case of iatrogenic disease or death, resulting directly from the careless use of one or more of the powerful tools of modern technology, is not enough to make us pause at least in our current blind admiration for technological sophistication.'

Rather than looking for new drugs it would probably be wiser to spend our resources on finding out how best to use the drugs we have. As Lord Rosenheim has said: 'I do sometimes wonder whether the vast sums of money now being spent, in many countries, on research, might not produce more rapid and spectacular improvement in world health if devoted to the application of what is already known.'

Louis S. Goodman said at a conference in 1963, when he was Professor and Chairman of the Department of Pharmacology at the University of Utah College of Medicine that 'the time has come for those responsible for the introduction of new drugs to reflect seriously on how they invest their share of the nation's limited supply of money, effort, time and scientific manpower.' Professor Goodman went on to say that he felt that most drug company employees knew whether the drugs they prepared were really useful or merely imitative and hopefully profitable.

As the clinical pharmacologist Dr Walter Modell pointed out in 1962 when testifying at the Kefauver hearings 'the excessive number of needless drugs constitutes a present danger. We can make the useful drugs both less dangerous and more efficient by weeding out the useless, the ineffective and the duplicates, and by so doing, make it possible for the physician to learn in depth about potent drugs he will prescribe for his patients.'

Dr Henry E. Simmons, Director of the Bureau of Drugs at the Food and Drug Administration supported this view in 1973: 'If twenty drugs are available for a condition, but only two are effective, it is critical to all patients and to the medical profession that a scientific determination be required to make certain that only the two effective remedies are available for use.'

We would perhaps also benefit more if money was spent on health education. We certainly need to review our requirements and priorities.

Finally, a quote from the late President Kennedy:

'The successful development of over nine thousand new drugs in the last twenty-five years has saved countless lives and relieved millions of victims of acute and chronic illnesses. However, the new drugs are being placed on the market with no requirements that there be either advance proof that they will be effective... or the prompt reporting of adverse reactions. These new drugs present greater hazards as well as greater potential benefits than ever before for they are widely used, they are often very potent, and they are promoted by aggressive sales campaigns that may tend to overstate their merits and fail to indicate the risks involved in their use.'

Sadly that is all still quite true.

NOTE
The essay above is taken from `The Medicine Men’ by Vernon Coleman. First published in 1975, `The Medicine Men’ was the first book to explore (and criticize) the relationship between the medical profession and the modern pharmaceutical industry. A new paperback edition of `The Medicine Men’ is now available from the bookshop on www.vernoncoleman.com Or CLICK HERE