With a world population of 7.5 billion people the value of the pharmaceutical industry is estimated to be in the region of one trillion dollars and is growing at an annual rate of 6% per year. These statistics translate into an annual investment for the development of new drugs of approximately $200 billion which often results in groundbreaking advances. These are breakthroughs as much in scientific equipment and synthesis methods as they are in the drugs themselves. Oftentimes such advances go by unnoticed. For instance, recent developments at the UK's National Physics Laboratory on a spectroscopic method (OrbiSIMS) has improved the efficiency of drug design and testing in an unprecedented way. Similarly, the development of protein busting chemicals (PROTAC) by researchers at Yale University has provided drug designers with a chemical toolkit that can revolutionise the effectiveness of medication by targeting harmful cells in ways previously unimagined. Apart from the pharmaceuticals market, an additional $300 billion is spent annually on medical devices which are deployed in clinics and hospitals. Given the significance of the entire health industry, the question is how did it come to be the behemoth which it is today and where might it ultimately lead?
The habit of consuming plants and sometimes minerals is practised instinctively by many animals when they are unwell. Unsurprisingly, our relationship with plants as a means of alleviating the effects of illness goes back to at least the Neolithic Age (about 10,000 years ago) and predates medicine entirely.
Records of medical practices first appeared in ancient China at around 5000 BC, in Egypt as far back as 3000 BC and Mesopotamia at around the same time, but these were mostly based on mystic beliefs and a mix of magic and magical potions. The Chinese Taoist physicians believed that illness was due to the impact of the environment on the soul and focused on the metaphysical aspects as a possible cause. Conversely, the Egyptians and Mesopotamians relied on physical examinations to provide diagnosis and prognosis but still relied on supernatural causes. By around 1000 BC the practice of administering a cure to an ailment based on observations had become established in India and in Greece.
Born on the island of Kos in 460 BC, the Greek physician Hippocrates is considered to be the founder of modern medicine. He is known for the "Hippocratic Oath" which doctors take when starting their careers and which defines their moral code. He established that all diseases were due to natural causes and directly linked to the environment, diet and lifestyle, dismissing supernatural causes as pure myths. However, medical progress during this time was restricted by the belief in the sanctity of the body which could not be violated by dissection. Medicine relied on diagnosis and passive treatments and was based on the concept of the humours, ie. blood, yellow bile, black bile and phlegm related to air, fire, earth and water respectively.
This practice endured through the Middle Ages and still relied on the work of the Greek scholars such as Galen (2nd century). The Medical Compendium written by Paul of Aegina during the 7th century included hundreds of diagnostic methods and drawings of the human skeleton with numerous detailed procedures for treating conditions and ailments. During this time Islamic physicians added to our understanding of medical subjects such as ophthalmology and surgery.
By the mid 1550s the universities of Padua and Bologna in Italy became renowned for their work on human anatomy. The publication of De Humani Corporis Fabrica by Julius Aranzi established anatomy as an indispensable field of medicine. This was the first of a number of major advances in medicine, further driven by the Swiss medic Paracelsus (who is considered the father of toxicology) and the Dutch scientist Antoine Leeuwenhoek who discovered the existence of bacteria.
The 18th century saw the Age of Enlightenment bring about a change in how science and inevitably medicine were perceived, with scientists and physicians being held in high esteem. 1721 saw the first major hospital in Britain (Guy's Hospital) open in London, and the British physician Thomas Percival wrote a code of medical ethics and conduct in 1767 which set the standard for medical text books throughout Europe.
It was the 19th century which saw a truly revolutionary change in the medical sciences, as religious and ethical concerns became less restrictive allowing work on cadavers to proceed. Chemistry brought improvements in techniques adopted from laboratory practices and developments in equipment. Hospitals were a great source of medical knowledge as doctors kept detailed notes of symptoms and diagnoses, and wartime field hospitals brought about much of our understanding of hygiene. Surgical interventions became more mainstream as antiseptics and anaesthetics became available, signifying the birth of the modern Pharmaceutical Industry in Germany. During the mid-1850s the French biologist Louis Pasteur proved that bacteria did not spontaneously generate, leading to a deeper appreciation of the sources of diseases and how they might spread, and the establishment of epidemiology. The end of the 1800s brought about the discovery of the nuclei in cells by the Swiss chemist Friedich Miescher. During this time hormones such as adrenaline were identified leading to the development of a number of drugs such as those used to control blood pressure.
The early 1900s saw the advent of barbiturates used for the treatment of conditions such as epilepsy, as well as the discovery of antibiotics such as Penicillin, used to tackle bacterial infections. The development of vaccines soon followed. The 1950s saw James Watson's and Francis Crick's work on DNA make a major impact, by showing how all life was comprised of the same building blocks and that the design of every living organism relied on the way in which the DNA in cells was sequenced. This formed the basis of genetics explaining Darwin's theory of evolution.
As the 20th century came to a close, efforts were being made at an international level to map the human genome. This work was completed on 14 April 2003 giving the pharmacologist an insight into the makeup of humankind at the cellular level.
The 21st century has already seen progress made in a couple of decades which far exceeds that made over the past 10,000 years. Our detailed understanding of anatomy, body chemistry and genetics has allowed us to pioneer treatments that are truly miraculous, overcoming diseases and ailments which were once considered fatal. With every decade that passes our average life expectancy increases by about three years, such that perhaps in time our medical knowledge may lead us to the fabled Elixir of Life.
Little Einstein’s Corner - Seeing Double
We usually use both eyes to do things. What happens when you only use one?
For these experiments you will need:
1. Ask your friend to close one eye. Give your friend the pencils to hold one in each hand. Ask your friend to bring the lead points together. How difficult is that?
2. Place the cup on a table. Now give your friend the coins and still with one eye closed ask your friend to drop the coins into the cup from a height of about half a meter. Is that easy or hard?
Now repeat these two experiments with both eyes open. It's much easier this way as our stereoscopic vision, which uses both eyes, allows us to judge distances correctly.