Bad Chymistrie

chymistrie

A friend of mine posted a meme on Facebook the other day that said this:

Why do they call it ‘alternative medicine’ when it is the ‘original medicine’ that humans have been using for thousands of years? Chemical medications were discovered about a 100 years ago!

That seems like a mild enough argument, though my friend is no fool and must have known she was posting an ad for a company that sells alternative health products and has some pretty scathing things to say about modern medicine. Since I can only handle so much controversy at once, I decided to focus on the 100 year figure. What chemical discoveries were they talking about?

You can see one difficulty right away: chemical isn’t an easy word to define. Even dictionaries routinely embarrass themselves trying, because in a perfectly real sense nearly everything is either a chemical, or made of chemicals. It’s hard to hold this line against the flood of popular usage, which says that chemicals are evil things made in factories. Add a measure of New Age alternative logic and it gets worse: there are plenty of people who’ll tell you that the fructose in high-fructose corn syrup is a toxic chemical, while the identical molecule inside an apple is “natural fruit sugar.” Or suppose you had malaria. Would you rather be treated with this stuff:

(R)-[(2S,5R)-5-ethenyl-1-azabicyclo[2.2.2]octan-2-yl]-(6-methoxyquinolin-4-yl)methanol

or with a tree-bark extract known for centuries to the Quechua people of Peru? It’s quinine either way. So stop struggling and just accept it: when a real chemical comes along we’ll know it when we see it. Everyone else does.

All right. As far as I can tell, Western medicine was pretty much non-chemical for a lot of its history. For centuries after Hippocrates, the fundamental idea was that the human body is filled with four natural substances or “humors.” These were, roughly in descending order of appeal, blood, phlegm, yellow bile, and black bile. Good health depended on the humors being in proper balance, and when things went wrong, doctors tried to restore balance by bleeding, sweating, or purging their patients. You could call this an early form of holistic medicine, and in an interesting parallel to certain of today’s controversies, it was challenged during the Renaissance by Paracelsus and his followers, who thought diseases could be treated by introducing inorganic compounds into the body. The Paracelsans fit the modern concept of the evil pharmacist pretty well. They were especially fond of heavy metals like mercury, lead, and arsenic. It was at this time, for example, that mercury became the standard treatment for syphilis, despite the unpleasant and sometimes fatal effects of mercury poisoning. Treatments like this were “chymical medicines” – the term appeared in medical texts by the 16th century, so it’s nearly as old as Modern English.

The theory of humors didn’t give way overnight. Moving forward to the early 19th century you still find physicians obsessed with expelling substances from the body, but by now there was an emphasis on making the expulsions particularly violent – this was the age of “heroic medicine,” which means about what it sounds like. Chemistry could help with that, too. A story they didn’t tell you in school about the Lewis and Clark expedition is that it carried a large supply of “Dr Rush’s Bilious Pills,” each of which contained a big dose of two powerful laxatives, one of them a mercury compound then called calomel. The pills were nicknamed “thunderclappers” (and if schoolchildren today are bored with history, my suggestion is that we teach more stuff like this in the fourth grade). As the Expedition moved westward, thunderclappers were freely dispensed to deal with not only digestive complaints but, apparently, any health problem from colds to venereal disease. Enough heavy-metal thunder was left along the way that modern historians have located parts of the expedition’s route by testing the soil for mercury.

We haven’t yet mentioned what may have been the most popular medicine in the 18th and 19th centuries. Laudanum, an alcoholic tincture of opium, is a Schedule II controlled substance today, but until 100 or so years ago it was a common household item: people in Victorian novels sometimes seem to be knocking it back at the slightest pretext. Many of the so-called patent medicines of the day contained opium as well (or for that matter, cannabis) though these weren’t always declared on the label. Since virtually all opium is produced agriculturally, it might qualify as a “natural” remedy today, but chemists were busy with the stuff early on, and by the 1830s they’d isolated some of its constituent alkaloids, notably morphine and codeine. The next step was to modify these compounds in the lab. An early and infamous example of a synthetic opiate is the morphine derivative brought to market in 1898 by the Bayer company, which thought for a while that it had found a less addictive alternative to morphine. It was called Heroin.

Bayer AG, based in what’s now Wuppertal, Germany, has a prominent place in any history of drugs. Its most famous product, of course, was Aspirin (now usually written with a lowercase A in countries like the US where the trademark has lapsed). According to the rules we’re trying to play by here, aspirin is probably a “chemical medication,” because while it resembles a substance found in willow bark and known to more than one ancient culture as a natural pain reliever, aspirin itself is a modification of that substance, designed in a laboratory to be easier on the digestive system. (It goes almost without saying that you can buy real willow bark on the Internet, at a large multiple of the price of aspirin, if you really want to.) Today, aspirin’s reputation doesn’t seem so bad, possibly because it’s been around so long it seems like a folk remedy in its own right. Another early Bayer product doesn’t strike us as quite so benign today: the first commercial barbiturate was sold in 1904 under the brand name Veronal. Barbiturates were useful sedatives, but they tended to be addictive and there’s a rather impressive list of celebrities who died by overdosing on them. They’re still used today, but only for a few specific purposes.

As you can see, there was a fair amount of chemical medicine already in circulation 100 years ago, and the overall result was fairly dismal. If you were constipated, you were in luck: chemists could fix that in spectacular fashion, but with nearly any other malady you ran out of options pretty quickly, except for understandably popular drugs for knocking yourself senseless. So what happened next?

Well, the “chemical medication” that’s probably nearest to 100 years old today was a product called Salvarsan, the first effective treatment for syphilis. Credited to Paul Ehrlich (the German, not the American), it was an arsenic-based compound with potentially unpleasant side effects, but it marked the first time that somebody went into a laboratory and came out with an effective cure for a horrible disease. Salvarsan went on the market in 1910. Erlich’s method – cook up as many different compounds as you can and try them all to see what works – became the basis of much modern pharmaceutical research, and it soon began to pay off. Sulfa drugs arrived in the 1930s: they were effective treatments for bacterial infections like pneumonia and meningitis, and they made a huge difference in the treatment of wounds, especially in World War II. Penicillin followed just as the war ended, and soon the whole field of modern antibiotics opened up. These discoveries revolutionized medicine; together with other scientific advances like vaccines and safer drinking water, they increased life expectancy at birth in the United States from about 50 (in 1910) to about 70 (in 1960). There’s no period of human history in which public health improved even remotely as much as in the rush of “chemical” research that began about 100 years ago.

I’m not sure, then, exactly what this is getting at:

Why do they call it ‘alternative medicine’ when it is the ‘original medicine’ that humans have been using for thousands of years? Chemical medications were discovered about a 100 years ago!

If it’s really just a quibble over the word alternative, fair enough. But there’s also the sleight-of-hand you may have noticed already: if “chemical medicine” dates at least to medieval times, then lots of alternative medicine turns out to be far more recent. Chiropractic started in 1895, Christian Science in the 1870s. (Homeopathy goes all the way back to the 1790s, but wait – homeopathy uses “chemicals.”) More important, what actually did begin a hundred years ago wasn’t chemical medicine but scientific medicine: the substitution of research for superstition, experiment for anecdote.

If people are still biased toward the old and the exotic, you can’t really blame them. Looking backward at the medical landscape today, the first thing you see is a new list of worries: new drug-resistant bacteria, scandals in research ethics, stalled offensives against many diseases. Before that, the dazzling half-century that doesn’t resonate with us any more, because it was so successful we hardly recognize the names of the victories: polio, diphtheria, smallpox. And before that, several centuries of black comedy when doctors seemed to torture their patients for no good reason and surgeons scoffed at the idea of washing their hands between operations. Who wouldn’t want to believe that if you keep going back, you eventually get to the uncorrupted wisdom, thousands of years old, that really knew how to treat an illness. If a functional time machine is ever invented, there’s going to be a stampede of sickly New Agers setting out for ancient Egypt or Mexico or Tibet intent on some serious medical tourism.

Hell, I might go. But I’m taking the medicine cabinet with me.

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