Thomas Hager – Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine (New York: Abrams Press, 2019)
Hager writes as a storyteller, rather than as a chemist. This makes a daunting subject much easier to approach. It also makes clear the significant progress medicine has made over the last several centuries. Though Hager argues that drug companies have already picked most of the low-hanging fruit, the next few decades will still see significant advances.
As he points out early on, he tells the stories of ten-ish drugs, not precisely ten. Each chapter is more about a group of drugs. The first chapter is about opiates and pain relievers, a category that likely includes more than ten notable drugs by itself. The good these drugs have done for surgical patients, women giving birth, and chronic pain patients is coupled with the problems of addiction and the inability of policymakers to deal with the problem with anything other than prohibition and restrictions. These policies, create more problems than they solve, which politicians are naturally proposing to address with more of the same.
Hager also tells the stories of antibiotics, which balance life-saving power versus rapid bacterial evolution; vaccines and inoculations, which have dealt with anti-vaxxer nonsense from the beginning of their thousand-year history; and other fascinating stories of progress and reaction, and innovation and suppression. The final category, of gene-based medicine, is flashing enormous potential right now, much of which is still unrealized. People with cancer, organ damage, birth defects, and genetic diseases such as sickle-cell anemia are all potential beneficiaries. However, they are threatened by a significant anti-science movement from both the right and the left.
This book came out in 2019, right before the COVID-19 pandemic. If Hager writes an afterword or an updated edition on the 2020 pandemic, it would be fascinating to see his thoughts on how the speed of invention has sped up over time.
For comparison, smallpox first appeared in third century, B.C. Egypt. It took more than a thousand years for the first inoculations to be invented in 9th century, A.D. China. It then took another 900 years or so for people like Lady Mary Wortley Montagu to popularize the practice in the 1700s, and then another 200 years to eradicate the disease entirely. In modern times, HIV/AIDS took decades, rather than centuries, to move from a death sentence to a chronic, usually manageable condition. Time will tell if COVID-19 is ever eradicated. But its timeline took a little more than a year from the disease’s first appearance to its vaccine being taken by millions. This is a big deal. For all the pain 2020 has brought, this record speed should be a strong source of optimism for dealing with the next pandemic—and for further progress with existing diseases.
Hager does a good job of staying neutral in his stories, though on several occasions he shows the intellectual’s common distaste for the idea that someone, somewhere, might be making a profit by helping people. Fortunately, he doesn’t go much into public policy in this book. He would likely have little to add that would help patients, speed innovation, or reduce costs—all of which profits incentivize.