What are drugs?
Momentarily purge yourself of any connotations
that come to mind, such that we can start
from scratch in examining this concept.
By definition, a drug is any substance that,
when introduced to the body, produces a non-nutritional
physiological effect.
This substance may be isolated and placed
in a capsule or tablet.
It may be present within a living organism,
like an herb, or some other kind of plant.
It may be of natural origin, or it may be
of human design.
Whatever the case may be, when it is ingested,
injected, topically applied, or otherwise
introduced to the body in some manner, it
does something in the body.
It modifies a physiological function in some
way, perhaps by enhancing it, perhaps by disrupting
it, or by silencing it completely.
Humans have been using drugs in a medicinal
context to treat disease since the beginning
of recorded history at least, and our relationship
with these substances has a rich and fascinating
history.
In this modern age, science seeks to broaden
our understanding of any and all natural phenomena,
with disease and medicine sitting right at
the top of the list.
What is disease, and how should we go about
treating it?
How is it precisely that drugs achieve their
intended effect?
Only through the development of chemistry
and related disciplines in the 20th century
have we even begun to have the ability to
answer these questions in a sophisticated
manner.
Nevertheless, we have always attempted to
answer these questions, even when we had no
knowledge of the molecular world.
Who were the people that first offered those
answers, and what did those answers look like?
In this series, we will discuss the history of drugs.
We will focus mainly on what are sometimes
referred to as “ethical drugs”, which
means drugs that are approved by health authorities
to cure or mitigate disease.
We will also touch on other types of drugs,
such as recreational drugs, because the division,
from a chemical point of view, is rather arbitrary,
and also because the histories of these two
classes have considerable overlap.
As we move through historical periods, from
the most ancient to the more modern, we will
eventually come to focus much of our discussion
on the development of the pharmaceutical industry,
which is where most drugs come from nowadays.
We will discuss the scientific achievements
of this industry, as well as its failings
and shortcomings.
Our approach will be balanced and objective,
as the goal will be neither to uncritically
celebrate this industry nor deprecate it for
its greed.
We will simply engage in an impartial analysis
of its practices over the decades.
A historical approach to the field of pharmacy
will undoubtedly give us the ability to recognize
how far medicine has come from its obscure
origins, and allow us to better appreciate
our more recent accomplishments in the human
endeavor to cure what ails us.
While this series will sometimes make reference
to concepts in chemistry, biochemistry, biology,
pharmacology, and other related fields, our
approach will be entirely historical.
No prior scientific knowledge will be assumed,
or strictly necessary to be able to appreciate
the people and events we will be discussing.
However, the more you know about science,
the more sense it will make, so if anything
we talk about here inspires a desire to learn
more about the molecular world, be sure to
visit my playlists in each of these subjects
to expand your knowledge of them.
But whatever your scientific background may
be, everyone loves a story, and this will
be a good one, so let’s begin.
Any historical assessment of the impact modern
science and medicine have had on human lives
must begin with a plot of this kind to establish
some context.
Here, average life expectancy is plotted against
the year of a person’s birth over the last
80 years or so.
We can see that in a general sense, the trend
is undeniably upwards.
This is evident when simply looking at the
overall average human life span.
This is also clear when looking at people
from specific groups of countries, whether
developed, developing, or undeveloped.
The average life span in the most developed
and egalitarian countries is already slightly
beyond the 80-year mark.
To expand into broader analysis, the current
life expectancy can be truly appreciated when
comparing with trends over the millennia.
Scientists have deduced, from several experiments
on ancient human remains, that the average
life span during the stone age was about 32
to 33 years.
The life of a hunter-gatherer was fraught
with peril, and although from a biological
standpoint people certainly could reach middle
age or even old age, in practice people were
frequently the victims of violent death, epidemics,
or starvation.
Then, around 12,000 to 14,000 years ago, people
started settling into larger communities,
and through a collection of oral and written
traditions, history was born.
The agricultural revolution allowed for the
emergence of human settlements that were much
more expansive than the small hunter-gatherer
bands constituting pre-agricultural societies.
The abandonment of the nomadic lifestyle had
major consequences, one of which was that
women could have many more children.
And these children, or at least those who
survived childhood, which were typically about
half, were useful in carrying out the heavy
chores of the farm.
A ramification of this shift can be seen in
tracing the size of the global human population
before and after this revolution.
Over the first few hundred thousand years
of existence on this planet, Homo sapiens
had been able to migrate from its cradle in
central Africa to essentially the entire world,
but there were only 1 to 2 million people total.
Over the first 10,000 years of the agricultural
revolution, this population ballooned to over
100 million.
Curiously, the establishment of villages and
agriculture did not result in a rise of the
average life span.
Actually, it dropped a little, probably as
a result of the less varied and more unhealthy
diet, as well as the faster spread of infectious
diseases in these larger settlements.
Amazingly, the average life span did not return
to that of the stone age until the 19th century.
Then, at the beginning of the 20th century,
major developments in chemistry, biology,
and medicine gave rise to truly scientific
approaches to the treatment of disease.
The pharmaceutical industry was born in order
to take advantage of these discoveries, and
the average life span started to increase
dramatically, more than doubling in less than
a century.
Of course, this increase is not only due to
the development of drugs, but also a combination
of hygienic factors.
But we believe the better treatment of diseases
was the key factor.
The eradication of a number of chronic diseases
also resulted in a dramatic improvement in
the quality of human life, something that
cannot be easily measured by charts, but can
be grasped qualitatively if we realize that
many of the diseases we can now treat did
not kill rapidly, but led to years, or even
decades of painful physical and mental decay.
This is the central theme that will be explored
throughout this series.
A sea change in the human experience has been
achieved by systematically addressing the
most common causes of death from a scientific
and empirical angle.
Given the universal concerns of humanity,
the goal of modern medicine is two-fold.
First, we seek to extend the human lifespan,
essentially indefinitely, and second, we seek
to improve the quality of life.
To contextualize this further, extending the
average human life span has always been a
primary goal of science.
We understand that our ability to pursue this
goal is not only scientific in nature, but
also political, and we presume that the prevailing
political conditions, at least in democratic
societies, will coincide with such a goal,
although this may not always be the case.
However, living a long life is not enough.
It is the quality of that life which is supremely
important.
That is, we want to enjoy the things, both
material and spiritual, which combine to make
life a worthwhile experience.
Whereas the definition of quality of life
differs from person to person, it is hard
to deny that good health is a necessary component,
even if insufficient by itself.
Therefore, combining these two points, it
is clear that we want to live as long as possible,
and in good health for as long as possible.
These are the goals of modern science-based
medicine, and they must be balanced against
the economic constraints a society has to face.
A side effect is that the average life expectancy
is higher in richer countries than in poorer ones.
While this may seem unjust, it is the reality
of our current politico-economic framework,
and is unlikely to change anytime soon.
But with these goals in mind, the pharmaceutical
industry has allied itself with modern medicine
to bring newer and better treatments to the patient.
The additional goal for the pharmaceutical
industry is, of course, to make money.
This goal is shared with every other industrial
enterprise in our capitalistic society, even
though this fact has given rise, now and then,
to public outrage.
We will explore this topic with some depth
later in the series.
But of course our primary goal is to examine
how medicinal drugs have achieved such stunning
and transformative results on human civilization.
We will go through some of the most relevant
people and events, without sparing the setbacks,
culminating in the work that might be done
in the future to improve on this landscape.
We will even examine the notion of achieving
so-called “biological immortality”, something
that may sound like science fiction, but which
actually can be dealt with scientifically,
and will demand a discussion of bioethics.
We will also briefly examine some of the economic
issues associated with these modern forms
of treatment.
This includes the cost to the patient, and
how society is handling the noble ideal of
providing state-of-the-art treatment to as
many patients as possible, while preserving
the rights of the innovator to make a reasonable
financial profit.
Where has this been successful, and where
does it fall short?
All of these questions will be addressed in a fact-based manner, as we examine the history of drugs.
