Best book I've read this year

Ten Drugs by Thomas Hager

It might be a bit too early to declare anything "best of the year," but I truly believe I've come across a gem. I just finished reading "Ten Drugs" by Thomas Hager, and it's an absolute masterpiece. The book discusses how plants, powders, and pills have shaped the history of medicine. It leaves you with an appreciation for how healthcare has evolved to what it is today.

I thought I’d mention three interesting stories that I learned about while reading the book.

1. Opium Wars

For the longest time, medicine was all-natural, consisting solely of plants and herbs. The challenge was that only 5% of the roughly 300,000 plant species on Earth were actually edible for humans. Yet somehow, our ancestors managed to figure out which ones were safe through a great deal of trial and error, often accompanied by tragedy.

One of those plants that our ancestors discovered was the poppy, which gave us opium. And it wasn't a recent discovery. Opium has been used as a drug for over 5000 years, prized for its pain-relieving and sedative properties. Initially, it was seen as a magical plant, a gift from the gods that could ease suffering and induce blissful sleep. Ancient civilizations, from the Sumerians to the Egyptians, Greeks, and Romans, all recognized and utilized the potent effects of opium in their medical practices.

However, as time went on, the darker side of opium became evident. Its addictive nature, began to wreak havoc on individuals and societies. The drug's euphoric effects led to widespread recreational use, resulting in severe addiction and dependency issues.

Here is what a 2,000-year-old medical book says about opium:

“It is a pain-easer, a sleep-causer, and a digester, helping coughs and abdominal cavity afflictions. Taken as a drink too often, it hurts (making men lethargic) and it kills.”

Not a lot has changed.

In the early 19th century, Britain faced a significant trade imbalance with China. The British imported vast quantities of tea, silk, and porcelain from China, but the Chinese had little interest in British goods. To solve this imbalance, British traders began exporting Indian-grown opium to China.

The Chinese government, recognizing the social and economic harm caused by widespread opium addiction, tried to stop the trade. In 1839, Chinese officials, led by Commissioner Lin Zexu, confiscated and destroyed over 20,000 chests of opium in Canton (Guangzhou). This action angered the British, who saw it as a violation of free trade principles.

In response, Britain launched the First Opium War (1839-1842). The superior military technology and naval power of the British led to a decisive victory. The Treaty of Nanking, which ended the war, imposed harsh terms on China, including the cession of Hong Kong to Britain, the opening of several ports to British trade, and the payment of a large indemnity.

There was a Second Opium War (1856-1860), and China faced another defeat. The treaties of Tianjin and Beijing further eroding its sovereignty, legalizing the opium trade, and granting foreign powers extraterritorial rights and more access to Chinese ports.

The Opium Wars marked a significant turning point in Chinese history, leading to a century of foreign domination and internal turmoil. They also highlighted the devastating impact of the opium trade, both in terms of addiction and the broader geopolitical consequences.

“The London Times estimated in 1888 that 70 percent of the adult males in China were addicted or habituated to the drug.”

The impact of opium on human history is profound, illustrating both the advancements and problems in the quest for pain relief, and pleasure.

2. Dairymaids got good skin

Smallpox was deadly. It killed millions, and none of the traditional cures seemed to work. Vaccines had not yet been invented, and so the disease was rampant. It was lethal, and the survivors often ended up with scars.

But not everyone. “English dairymaids, the girls who milked the cows every morning, tended to be rosy-cheeked, creamy-skinned, and—most importantly unscarred by the pox.”

It turns out that cows were sometimes spotted with a mild disease called cowpox. It looked a bit like smallpox but was no real threat. Dairymaids often picked it up on their hands while milking, getting a spotty rash that passed after a few days. After that, they rarely got smallpox.

This accidental inoculation through cowpox provided immunity to smallpox. Interestingly the word “Vaccination” comes from vacca - latin for “cow.”

3. Pink Mice

Deaths from wound infections in the Second World War were a small fraction of what they had been in the first. Why? Antibiotics.

Penicillin is often credited as the first antibiotic, but the book brings our attention to something that happened before. Without going into too much detail, here’s the story:

The pharmaceutical giant Bayer was focused on solving bacterial infections. It was known that certain dyes could selectively stain certain tissues while ignoring others. A property deemed useful to tackle bacteria. Given that Bayer began its business manufacturing dyes, it decided to explore this avenue.

They hired Gerhard Domagk, a doctor who had served in hospitals during World War I. He had witnessed first-hand the deaths caused by bacterial infections. Determined to find a solution, Domagk started working with Bayer in 1927. He set up state-of-the-art labs where he tested each new chemical in two ways.

1. The first was to mix it with disease-causing bacteria in a test tube to see if it would kill them. This was the less important of the two tests: plenty of chemicals, from bleach to pure alcohol, could kill bacteria in a test tube. That didn’t mean they would make good medicines.

2. The second, more important, screening was in live animals. Mice would be injected with a strain of the disease and then injected with the chemical. Their survival would indicate that the drug may be working.

Domagk’s test system was working perfectly; he had created a flawless mechanism for uncovering new medicines. Unfortunately, success took a while—five years, in fact.

It was not until 1932, while testing various synthetic dyes, that Domagk’s team found a promising compound. Tests showed that this dye could protect mice from bacterial infections. One of the only side effects was that the red-colored medicine temporarily dyed the skin of the mice pink.

It was fantastic news. The entire team was excited. After five years of trials, they had finally achieved success. And then, Bayer went silent. There was no big announcement, no scientific papers, no news stories, and no sales. It would take two years before Domagk published his first scientific paper on the discovery.

It turned out that the exact mechanism of how the dye worked was not clear. It was initially believed that the dye itself was responsible for the antibacterial effects. Subsequent research by other scientists, revealed a surprising discovery. It was not the dye itself that had the antibacterial properties but a side-chain compound that was used with the dye. The compound was sulfanilamide, known as Sulfa.

Sulfa was common. It had been available for decades, its original patent had expired; it was inexpensive, simple to manufacture, and widely available in large quantities. Not great news for Bayer. Nevertheless, this discovery was ground-breaking. Sulfa became the first effective systemic antibiotic, saving countless lives.

Domagk's work earned him the Nobel Prize. However, he was forced to decline the award by the Nazi regime. He eventually received the prize after World War II.

Like these three stories, the book has ten chapters, with each chapter discussing a different drug. As mentioned before, I loved reading it and highly recommend it. (The book is "Ten Drugs" by Thomas Hager.)