In the same week that I read this outstanding book on the development of pharmacology, the newspapers were full of issues on which this book has a bearing and something significant to say.
In 1898, Burch points out that a new drug was developed and marketed for the treatment of tuberculosis by Bayer. TB is such an ancient enemy of man that there is apparently evidence of an earlier strain to be found in Egyptian mummies. The German firm had discovered a chemical that seemed to work well, and the staff they tested it upon seemed to respond well-it was called Heroin- and its addictive effects were at first missed. Just this week a group of paediatricians from a variety of hospitals, from Great Ormond Street to St James’s in Leeds, are concerned that in 2010 pharmaceutical companies are paying too little attention to funding research for babies and children. Why? Because it is less profitable than spending an equivalent amount of money on the development of medicines for adults. The history of the development of Aspirin appears on Bayer’s website but the marketing of Heroin – initially believed therapeutic, was abandoned by them in 1913-but not all firms- is not recorded.
An outstanding aspect of this stimulating and riveting read is its description of the heroic roles played by courageous men like Lind and Cochrane. The latter’s insistence upon weighing the evidence by careful statistical analysis in comparative groups was based on bitter experience of treating his fellow prisoners in the woeful conditions imposed by sadistic German guards in Salonika. Despite the shortage of available treatments the whole experience taught him the benefits of making his own careful comparative assessments. He had already fought fascism in the Spanish civil war and seen his friend Julian Bell die from a wound in a shattered thorax. After such experiences he committed his later days to introducing methodological rigour to medical research in relation to statistics and in the author’s telling phrase, ”having a more profound effect on human health than any newly discovered drug. One of the diseases on which their ideas most quickly had an effect was tuberculosis”. Because of its latency period after infection TB is still something of a problem for elderly patients, it was said on the radio this week. Its genes also mutate. However, the structured argument that Druin Burch pursues has contemporary relevance and careful historic research. His brief and concise pen portraits have the elegance of Aubrey’s “Brief Lives” to which he makes passing reference.
In a significant recent article in the national press Hadley Freeman, characterised the noughties as an age of fakery, in both science and medicine. She refers to Mike Specter’s new commentary on the MMR and autism furore. She mentions views pronounced by personalities from Ace Ventura, Tony Blair, Jim Carey and others on an issue which is likely to mislead vulnerable members of the public away from fact and experience. In “Taking the Medicine”, Druin referring to the fascinating figure of Boston’s nineteenth century physician, Oliver Wendell Holmes, refers to this propensity of patients to grasp at straws to find a cure and to pay for it. He states with an engaging touch of irony,”Like politicians who need to be seen to be doing-something-anything-about problems that are actually beyond their control, doctors are pushed into playing a part. The danger comes when they start to believe in their own illusory importance.”
In the next year or so, genetics advances will help to identify genetic sequences that drive patient’s cancers. Such work depends upon the earlier endeavours of figures like Paul Ehrlich who developed the effective use of chemical dyes, in haematology, to discover an effective description of the way in which living cells produce antibodies which led to a greater understanding of the immune system. The award of the first Nobel prize for medicine was, however blocked by an anti-Semitic chemist. Ehrlich went on, as Burch so clearly describes to test Salvarsan on animals with Saachiro Hata who had arrived from Tokyo in 1909. This led to the effective treatment of syphilis which, “held a position roughly equivalent to that of AIDS before the development of anti-retrovirals”. Ehrlich who was a kind and inspiring figure, Domagk his student, after a terrible time on the Western Front worked on the development of the first antibiotic which was needed to tackle puerpal fever- often lethal for women after childbirth- and meningitis until 1939. Dogmagk was to receive the Nobel prize but which under Hitler’s influence, he was made to refuse. He was still taken away by the Gestapo as his refusal was too polite.
Altogether this is an intelligent, wide ranging and stimulating read. The sort of book you hope that a sixth form biologist would find time to read and should be a supplement to the reading list in the first year at medical school-or” Knowledge Spas” they are named here in Cornwall. The author is an NHS doctor and his book is a thoroughly enjoyable, much easier than many medicines are to swallow!