Ten Drugs

Opium was known as “the gods’ plant”

Isolating alkaloids from opiates → codeine, morphine, etc.

Higher purity and dosage control than the opium of old

Also, more precise ways of dosing compared to the past. Syringe was a huge advancement.

Bigger, faster rush → higher risk of addiction. Citizens grew poppies as part of the war effort since morphine was so widely used in the wars. → morphinism → drug rehab industry, with almost no legal oversight

Inoculation with smallpox → vaccine with a similar disease in cows (cow pox)

Vaccine name is actually from cows, “vaca” in Spanish

Up through the early 1900’s Americans effectively had the right to self medicate. There were very few regulations around reporting. People could mail order heroin to their houses.

Organic opiates → semi synthetic opiates (heroin) → fully synthetic opiates (fentanyl)

They got increasingly powerful, but never less addictive

Pfizer does better when it’s medicines treat symptoms, not causes.

NARCAN (Naloxone) is way better at binding to receptors in the brain than opioids. This can lead to major immediate withdrawal, but it can be lifesaving in the event of an overdose

In part because of how advanced our drugs are, we have such a low tolerance for any kind of pain . There’s no evidence the US suffers from more pain than other countries, and yet we use way more drugs

Many of the diseases we know how to treat have a single cause, for which we have developed singular cures. Think vaccines and antibiotics. In the case of cancer and heart disease, we increasingly find there is no one cause. It’s not just cholesterol. Statins are not the end all be all. They just help to mitigate one risk factor, among many risk factors.

Statins are among the safest drugs that we have ever developed, and yet it is hard to assess statistically rigorously their long term effects. They can cause muscle pain and weakness, and some think can increase your risk for diabetes. We have moved the goalposts over time with respect to who should be advised to take statins, and the cost benefit trade off does not make as much sense for those who are only at moderate risk fir developing a severe cardiovascular health issue.

Not very statistically rigorous results are presented in ads in relative terms rather than absolute terms. Some believe that they are more comprehensive treatment than they actually are are and as a result lead less healthy lifestyles (worse diets or less exercise)

An amazing thing about the immune system is the level of abstraction that it works at—-capable of working against invading substances which are fully synthesized (something our evolutionary ancestors Willie never have faced)

Monochlonal antibodies (MABs) are, in some ways, the targeted silver bullet-type drugs that we have been looking for. Whereas most drugs discussed earlier in the book were “simple” molecules, these are highly complex biological chemicals. They are expensive and don’t work in all cases, yet for some they are cures to diseases that were death sentences to previous generations.

Super computers, protein folding programs allow quicker iteration digitally. We can understand the shape of drugs, and thus how they interact with the body, before we actually make and test them.

Personalized medicine can lead to more precise dosages or even drugs based on our personal characteristics. Dosages today are based on statistical averages that don’t work for everyone.