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5 Drugs That Revolutionized The Medical Landscape

Discussion in 'Pharmacology' started by Mahmoud Abudeif, Dec 3, 2019.

  1. Mahmoud Abudeif

    Mahmoud Abudeif Golden Member

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    It’s easy to take certain drugs for granted, almost as if they’ve always been around. We often don’t think twice about the years of research, trial and error, and costs associated with the pills we pull out of our medicine cabinets. But it wasn’t too long ago that some of the most revolutionary—now commonplace—agents and therapies we have today seemed as elusive as the cure for cancer.

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    With this in mind, our editors at MDLinx have curated a list of drug inventions that have changed the course of history and medicine. Although there were many contenders, these drugs were carefully selected for their positive benefit/risk ratio, effective use in large populations or ability to be used across a range of diseases, and contribution to the advancement of medical research and innovation.

    Morphine

    First up on our list is morphine, which you may be surprised to learn was first discovered more than 200 years ago by Friedrich Wilhelm Adam Sertürner in 1804. An unlikely innovator, Sertürner lacked formal education, and discovered morphine when he was just 21 years old and working as a pharmacist’s assistant. Intrigued by the analgesic properties of opium, he completed a series of experiments that isolated an organic alkaloid compound from the resin of opium poppy.

    In 1806, he published his results, and spent the next several years experimenting with the drug on others and himself. Importantly, he found that the alkaloid in opium caused its effects, and his work was foundational in the field of alkaloid chemistry. Sertürner named morphine after Morpheus, the Greek god of dreams, given its soporific effects.

    Although morphine’s addictive potential has cast a dark cloud on its use, its value as the basis of modern pain management cannot be overlooked.

    Insulin

    Before the advent of insulin therapy, patients with diabetes had limited treatment options, which oftentimes resulted in poor outcomes, namely death. In the early 20th century, various researchers strove to find a better solution, and between 1900 and 1920, developed pancreas extracts that worked to reduce blood sugar levels and glycosuria in animal models. However, because these extracts were impure, they were toxic to humans with diabetes.

    In 1921, Frederick G. Banting, MD, an orthopedic surgeon, and Charles Best, a student assistant, managed to extract “insulin” from whole beef pancreas, which was then used to successfully treat patients with diabetes. Of note, successful administration of insulin in humans also depended on the discovery of diagnostic methods to determine blood sugar using small volumes of blood. For his contribution to the field of medicine, Dr. Banting received the Nobel Prize in Physiology or Medicine in 1923.

    Regarded as one of the greatest events in the history of disease treatment, the discovery of insulin greatly extended the life-span of patients with diabetes, and is considered the grandfather of all following hormone-replacement therapies.

    Oral contraceptives

    One of the most controversial drugs ever created, oral contraceptives has undoubtedly had vast rippling medical and social effects worldwide by giving women control over their bodies.

    In the late 1930s, researchers of animal models showed that high-dose progesterone could stop ovulation, and by the late 1940s, chemist Carl Djerassi, PhD, managed to synthesize progestin from Mexican wild yam root, thus developing the first oral contraceptive pill for women. But, discovery turned out to be the easy part.

    The pill was first prescribed for “cycle control” among married women because prescribing for “contraception” was not only taboo—it was illegal. The Comstock Law forbade public discussion about contraception, as well as research on the topic. Incredibly, the concept of contraception was equated with pornography.

    Initial iterations of the pill contained excessive amounts of progestin, which raised risk for venous thromboembolism. Although these concerns were voiced about progestin use as early as 1934, it wasn’t until 1967 that these effects were more widely acknowledged.

    Although the 1960s and 1970s brought somewhat more empowerment to women with the rise of the women’s movement, the pill brought baseless concerns that women using it would become sexually promiscuous, and that “sexual anarchy” would ensue. In reality, all women wanted was self-determination over issues of contraception.

    It wasn’t until the 1980s that safe use of the pill became a reality:

    “Women began to have expanded choice with the introduction of new doses, new progestins, and new multiphasic pills. Alongside these changes and within this climate of uncertainty, acceptance of family planning was the norm, and women were now substantially increasing their numbers in medicine and other professional careers. Birth control clinics were abundant and often staffed by female physicians,” wrote the authors of one review article.

    Aspirin

    Despite the increased scrutiny of the benefit/risk profile of aspirin for daily use, it’s clear that the drug has had a resounding impact on the treatment of pain and some cardiovascular diseases.

    For a long time, people believed that Felix Hoffman discovered aspirin at the behest of his father who had rheumatism and desired a drug without the adverse effects of sodium salicylate. Hoffman worked as a chemist at Friedrich Bayer & Co, at the time a dye manufacturer. After reviewing the literature, Hoffman came across the formula for acetylsalicylic acid, and prepared it in 1897. In 1899, the drug was marketed under the trademark of Aspirin. Although quaint, this account is likely apocryphal. In 1949, Arthur Eichengrün, a colleague of Hoffman’s at Bayer, said that he guided and helped Hoffman to develop the drug.

    More than a century after its invention, aspirin is still widely recommended and used, and has been shown to not only alleviate simple pain, but fight inflammation and protect against some cancer types.

    Penicillin

    No list would be complete without the inclusion of penicillin. This life-saving drug’s profound and immediate effect throughout history cannot be overstated. Put simply, before the discovery of penicillin, a serious infection was akin to a death sentence.

    In 1928, bacteriologist Sir Alexander Fleming returned from vacation to find a zone of no bacterial growth surrounding an invading fungus on an agar plate. The mold was of the Penicillium genus. Consequently, Fleming named the extract he took from the mold “penicillin,” which exerted antibacterial properties against Staphylococcus and other gram-positive bacteria.

    Fleming published findings from his discovery in 1929, but found that isolating the active ingredient in the mold would turn out to be a real challenge. Fleming sent to mold to anybody who asked because he hoped whatever magic it contained could be extracted, but by the early 1930s interest waned.

    In 1939, researchers at Oxford—Ernst Chain and Howard Florey—managed to purify penicillin from the extract, and tested it in infected mice with great success. In 1941, penicillin was tested in a human for the first time. The patient was an Oxford policeman with a serious infection that covered him in abscesses. After 24 hours, his improvement was remarkable, but the Oxford team lacked enough purified penicillin to complete treatment and, unfortunately, the patient died several weeks later. Subsequent patients who were treated with penicillin at Oxford, however, recovered from their infections.

    Penicillin’s discovery led to the creation of many other antibiotics, which have saved countless lives, as underscored by Robert Gaynes, MD, professor, Emory University School of Medicine, Decatur, GA, in a review article published in Emerging Infectious Diseases:

    “Penicillin’s colossal effects led to the awarding of the Nobel Prize in Medicine and Physiology in 1945 to Fleming, Chain, and Florey. Penicillin was isolated from other microorganisms, which led to a new term, antibiotics. Using similar discovery and production techniques, researchers discovered many other antibiotics in the 1940s and 1950s: streptomycin, chloramphenicol, erythromycin, vancomycin, and others.”

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