In their lifetime, the average American could swallow more than 50,000 pills. This is a staggering amount to think about, but as populations live longer and the drugs we use to cure illness and disease become more advanced, hardly a surprising one.
To understand why we take so many pills, we need to understand the history of medicinal drugs; from the herbal remedies of the middle ages to the pills produced by “Big Pharma” today, illicit drugs or well-known legal medication, like statins and Viagra, they have all played a part in the drug culture of modern medicine.
In his book Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine (£18.99, Abrams), Thomas Hager explores the landmark drugs that changed medical practice, finding out how they were discovered, what goes into making them and why they made such a significant impact on our society.
Below is an extract from the introduction of the book, where we find out where the word ‘drug’ came from, when our attitudes to medication began to change, and the alarming amount of money that is spent on drugs every year.
On a business trip years ago, I had an extra day in London. So like many tourists, I headed to the British Museum. And there I ran across something extraordinary.
In a large, light-filled gallery on the ground floor was a table covered with thousands of pills. It was an exhibit conceived by an artist and a doctor who had come up with a way to display all the 14,000 doses of prescription drugs an average Briton took in a lifetime. These pills, woven into lengths of fabric and accompanied by bits of explanatory text, covered a gallery table that stretched forty-six feet. I couldn’t believe what I was seeing. Did people really take this many pills?
The answer is: No. They take more. The display was geared for Britain. And when it comes to taking drugs, the British don’t come close to Americans. More than half of all Americans take at least one prescription drug on a regular basis, and most of those who fall into that group take more than one (somewhere between four and twelve prescriptions per person per year, depending on which study you look at). One expert estimates that Americans take an average of ten pills per person per day. Add in non-prescription drugs—over-the-counter vitamins, cold and flu remedies, aspirin, and other supplements—and run the numbers: Let’s say a low-ball estimate of two pills per day per American over an average seventy-eight-plus years of life. The total comes to somewhere more than 50,000 pills, on average, in the average American’s lifetime. And there’s a good chance it’s a lot more. America consumes more pharmaceuticals than any other nation on earth, and we spend a lot more to get them: more than $34 billion each year on over-the-counter drugs, and $270 billion on prescription drugs. That’s way beyond what any other nation spends, because our drug prices are a lot higher than any other nation’s. Americans constitute less than 5 percent of the world population but spend more than 50 percent of the money that flows into the world’s drug companies.
And that’s not even counting illegal drugs.
No nation in human history has taken as many drugs or spent as much money to get them as the United States does today. And the drugs have had profound effects. They have added decades to our average life spans, playing a central role in the graying of America. Drugs have changed the social and professional options of women. Drugs have altered the ways we view our minds, changed our attitudes toward the law, shifted international relations, and triggered wars.
By these measures, perhaps we should rename our species Homo pharmacum, the species that makes and takes drugs. We are the People of the Pill.
This book will introduce you to how we got here, with a focus on medical (that is, legal, non-recreational, mostly prescription) drugs. It is written as a series of brief, vivid sketches, sort of mini-biographies of ten drugs that changed medical history, linked by common themes, with each story leading into the next.
One of those common themes is the evolution of drugs. The word drug itself comes from old French and Dutch terms for the barrels once used to keep herbs dry. Pharmacists 150 years ago were in many ways like today’s herbalists, extracting and compounding their medicines for the most part from jars of dried plants. That gave doctors in the 1800s a couple-dozen somewhat effective natural medicines to help their patients (along with hundreds of useless, often alcohol-rich elixirs, poultices, and pills made and ballyhooed by local pharmacists). Today we have ten-thousand-plus, ever-more-targeted, increasingly powerful high-tech medicines that can treat and often cure conditions that have confounded healers for thousands of years.
Wrapped in this evolution and guiding its trajectory is humanity’s search for magic bullets, medicines that can unerringly seek out and destroy diseases in our bodies without doing any harm to our health along the way. The goal has always been to find medicines that are all-powerful, but without any risk. That is likely an impossible goal. We haven’t yet found a perfect magic bullet. But we keep inching closer.
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Another thread that runs through these chapters tells a bit about the growth of the industry that makes drugs—the trillion-dollar behemoth that critics have dubbed “Big Pharma”—and changes in the ways we regulate that industry. For instance, in the 1880s you could get just about any drug you wanted without a prescription, over the counter, including mixtures laced with opium, cocaine, and cannabis. Now you need a prescription for almost any powerful medicinal drug, and even with a prescription you can’t buy narcotics like heroin (well, at least not in the United States). Drugmakers before 1938 could put just about anything they wanted on the market as long as it didn’t kill you, and they didn’t try to fool you with false advertising. Today, prescription drugs have to be proven both safe and effective before they can be sold. These laws governing our drugs evolved, in sometimes surprising ways, along with the drugs themselves.
Our attitudes have changed, too. In the 1880s, most people considered the right to self-medicate as something close to inalienable. It didn’t matter if a drug was good for you or not, deciding whether to take it was your choice, not your doctor’s. If you wanted to buy one of the many patent medicine horrors available from local drugstores, anything from radioactive water for cancer to opium-spiked syrups for insomnia, well, it was your body. Nobody had the right to tell you otherwise.
Today that’s been turned on its head. Now physicians hold the keys (in the form of their prescription pads) to getting most drugs. Today, when it comes to taking our medicine, we pretty much do as we’re told.
Drugs changed the practice of medicine, too. In the 1880s, doctors were family counselors good at diagnosing ailments and providing solace and advice to relatives, but almost powerless to alter the course of killer diseases. Today, physicians are able to work miracles of lifesaving that their brethren a century ago could only dream of. They are also all too often overscheduled, data-stuffed technocrats more comfortable reading lab reports than holding a patient’s hand.
During the past sixty years, the average life expectancy for Americans has lengthened by two months each year—mostly because of drugs. Vaccines have allowed us to completely conquer age-old enemies like smallpox (and we’re closing in on polio). Prescription drugs, along with public health efforts, have made our lives much longer and, in general, healthier.
Not that there aren’t also great risks. Drug overdoses, from both legal and illegal sources, are killing around 64,000 people each year, an annual death toll that exceeds all U.S. military deaths in all the years of the Vietnam War.
Here’s what drugs have done for us: In the bad old days, say two hundred years ago, men lived twice as long, on average, as women (mostly because of the dangers of childbearing and -birth). And everybody in general lived about half as long as they do today. A lot of that was tied to death early in life. If babies made it through the risks and traumas of childbirth, survived the epidemic diseases of childhood—smallpox, measles, whooping cough, diphtheria, and more—and made it to adulthood, they could be considered lucky. Because then they could die of consumption, quinsy, cholera, erysipelas, gangrene, dropsy, syphilis, scarlet fever, or any of a few dozen other diseases that we don’t hear much about anymore. Today we die from heart disease and cancer, diseases of the middle-aged and elderly. People in the old days didn’t worry too much about heart disease or cancer because few people in the old days lived long enough to get them. Thanks to drugs, a group of scientists recently wrote, “People have different diseases, doctors hold different ideas about those diseases, and diseases carry different meanings in society.”
As you’ll see in this book, vaccines and antibiotics moved us from being helpless victims of epidemics to being able to fight them off. Combined with more effective public health measures—cleaner drinking water, better sewage systems, better hospitals—drugs moved us from fearing the diseases of childhood to suffering the diseases of the old. That’s a tribute to medicine in general, and to drugs in particular.
These are technological tools capable of changing our culture. But when you think about them, drugs are even stranger than that. Today’s pharmaceuticals are high-tech, developed in cutting-edge laboratories after investments of tens of millions of dollars, but a kind of high-tech so intimate, so personal, that they have to become part of you to do their work. You have to snort them, drink them, ingest them, inject them, rub them into your skin, make them part of your body. They dissolve inside you and race through your blood from muscle to heart, liver to brain. Only then, when they are absorbed, when they have melted into you and melded with you, does their power unfold. Then they can attach and trigger, soothe and calm, destroy and protect, alter your consciousness, restore your health. They can jack you up or chill you out. They can addict you, and they can save your life.
What gives them this power? Are they animal, vegetable, or mineral? All of the above. Are they good for you? Often. Are they dangerous? Always. Can they perform miracles? They can. Can they enslave us? Some do.
This is an edited extract from Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine by Thomas Hager (£18.99, Abrams Press)