Susan Aldridge surveys a story of drugs discovery

Laughing Gas, Viagra, and Lipitor: The Human Stories Behing the Drugs We Use, by Jie Jack Li (Oxford University Press, hardback,2006)

Most of us have gained some benefit from medicinal drugs: a course of antibiotics to clear up an infection, painkillers, or maybe even a lifesaver such as a ‘clotbuster’ after a heart attack or stroke. The modern era of drug discovery stretches from penicillin and aspirin through to statins, Viagra, and the newest anti-cancer drugs like Herceptin.

Drug discovery can be an exciting and challenging business. Of thousands of potential ‘lead’ molecules entering a research
programme in cancer or infectious disease,it is likely that only one or two will ever reach the clinic, but these may have the potential to save millions of lives or greatly improve their quality.

The stakes in the pharmaceutical industry are very high, both in terms of money and time invested, and for human health. And the industry gets some bad press; it often seems in need of people to give an inside view to the public that they will listen to and learn from.This book goes some way towards providing that balance.

Role of chance

Jie Jack Li is a medicinal chemist; in the opening to Laughing Gas, Viagra and Lipitor,he says, ‘I strongly believe that man, if given enough time, can overcome any medical problem’. He backs this optimistic view by describing how medicinal chemists went about the discovery of antibiotics,
anaesthetics, anti-inflammatories, the Pill,and drugs for cancer, diabetes, AIDS and mental illness.

Louis Pasteur said: ‘In the field of experimentation, chance favours the prepared mind’, and this is as true in medicinal chemistry as in any other field of scientific endeavour. Luck and insight played a huge role in the discoveries of lithium for manic depression, Viagra, which has turned out to be a real ‘blockbuster’ of a drug and, perhaps the best known example, penicillin.

More history than human

The pharmaceutical industry is short of medicinal chemists, and it would be nice if a book about their achievements inspired a few young people to take up the challenge of finding a drug to treat Alzheimer’s or a vaccine for malaria – both of which the world desperately needs.Li promises to tell us the‘human stories’ behind the drugs we rely on.

A good example is the story of Gertrude Elion, who discovered no fewer than six of the early anti-cancer drugs and was the first woman to reach the Inventor’s Hall of Fame. An impressive achievement, and it is touching
to learn that what really made her happy was receiving letters from patients and their families who had benefited from her medicines. Then there was the battle between Horace Wells, William Morton and Charles Jackson in the nineteenth century over who should have credit for the discovery of the anaesthetic properties of ether – a struggle which destroyed the lives of all three.

But apart from these few gems, the book is actually rather short on real human interest, being more of a detailed historical account of who discovered what and when.

Strengths and weaknesses

The two best chapters are those on anticancer drugs and anaesthetics. The first givessome excellent descriptions on how the latest anti-cancer drugs – such as Tarceva, Iressa and Gleevec – actually work, which is very useful reading for anyone affected by cancer. The second reminds us of just how much we have to be grateful for, with some grim detail of what life was like before effective analgesia. It is also good to get a balancedview on the background to Vioxx, the arthritis drug that was withdrawn in 2004 because a clinical trial showed it increases the risk of a heart attack.

But Li sometimes takes too much for granted on the part of his readers. Forinstance, talking of rosiglitazone – an important new drug for diabetes – and its molecular relatives, he says, ‘It was only recently that they were all found to be peroxisome proliferator-activated receptor-Y
agonists, without any further explanation.

Li is right to point to the valuable contributions that medicinal chemists have made to humanity. However, he says little about where future medicines are going to come from. Small molecule drugs – the domain of the medicinal chemist – will continue to be important. But they will,increasingly, be matched by the products of the biotechnology industry: DNA vaccines,gene therapies, recombinant proteins like human insulin, monoclonal antibodies for cancer, and stem cell therapies. These will be as revolutionary for human health in this century as penicillin was in the last one.

Dr Susan Aldridge is a freelance writer and editor specialising in science and medicine. Her latest book is Use your Brain to Beat Addiction (Cassell, 2005)