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.