Wonder Drugs

This was standard treatment for pretty much any serious ailment in the late 18th century, but it wasn’t the only medical strategy available. Washington’s physicians also coated the patient’s neck with a paste of wax and beef fat, mixed with the secretions of dried beetles, an irritant potent enough to blister the skin—and, it was believed, to remove disease-causing poisons. Washington also gargled with a potion of molasses, vinegar, and butter, and his legs were covered with a poultice of wheat bran. He was given an enema and a purgative made of mercurous chloride.

None of this worked. By nightfall Washington was dead.

Now fast-forward to another patient in another sickbed, a century and a half later. On Valentine’s Day 1942, Anne Miller, following a miscarriage in the New Haven Hospital, started experiencing extreme chills and her temperature spiked to 106 degrees. Her diagnosis was blood poisoning, or, more technically, hemolytic streptococcal septicemia.

Her condition was rapidly deteriorating. She was given blood transfusions, rattlesnake serum, and even the new sulfa drugs, but nothing stopped the proliferation of the deadly bacteria. As a last resort, her physician pulled strings to obtain a supply of penicillin, at that time one of the rarest substances in the world. The hospital received five and a half ounces of the brown powder, which her doctor meted out to her throughout the night, guessing at the proper dosage.

By the next day, Anne Miller’s fever had dropped to 99 degrees, and she was sitting up and eating. She was the first person in the world to have her life saved by penicillin. She would go on to live another 57 years, and although few today even know her name, her miraculous survival ushered in the age of antibiotics.

Most people alive today do not recall the time before antibiotics, when a mere finger prick could be fatal. Happily, nobody remembers the so-called “era of heroic medicine,” when physicians— like Washington’s—tried anything and everything they could imagine in their sometimes bizarre and mostly futile efforts against infectious disease. William Rosen’s Miracle Cure, published last year in hardcover and ebook formats and coming out soon in paperback, traces in compelling detail the twisted route that led from George Washington’s deathbed to Anne Miller’s miraculous survival. Along the way, we observe the scientific minds whose laboratory insights slowly and incrementally translated into clinical practices that have changed our world.

George Washington probably died of an infection of his epiglottis caused by the pathogen Haemophilus influenzae type B, the same microbe that causes bacterial meningitis. At least that’s medical historians’ prevailing retrospective diagnosis. But it would be unfair and pointless to fault his physicians for malpractice, since they didn’t even know what a germ was. They were practicing a brand of medicine that hadn’t changed much for more than a thousand years, one based on the erroneous belief that disease was caused by an imbalance in bodily humors. Indeed, bloodletting—a practice popularized by the teachings of the 2nd-century Greek physician Galen—was an attempt to restore humoral balance.

Humoral theory persisted well into the 19th century, and arguably even had some pockets of influence into the 20th century. These ideas were able to persist so long because there simply was no superior alternative. This would start to change due to the basic scientific work of two 19th-century rivals, Louis Pasteur and Robert Koch. One of Rosen’s gifts as a science writer and historian is that he brings to life the scientists—their often big but flawed personalities—whose insights were so crucial to scientific progress. In the case of Pasteur and Koch, this included extreme nationalism, as much France versus Germany as Pasteur versus Koch, in the quest to revolutionize human biology.

This fierce competition produced germ theory, the scientific foundation of most of what came later, from antibiotics to new kinds of vaccines. The rivals’ work showed that many of the scourges of the time—cholera, plague, tuberculosis, diphtheria, and more—had nothing to do with the imaginary bile and phlegm, but instead were caused by invisible microbes.

Many scientists have stood on these pioneers’ shoulders, and Rosen narrates this painstaking medical adventure thoroughly and plainly. Among the heroes: Joseph Lister, a surgeon who pioneered the radical notion of antiseptic surgery and sterilization of instruments and wounds. Paul Ehrlich, who championed the idea of a “magic bullet”—a therapeutic agent that targeted specific disease-causing organisms. Gerhard Domagk, the German pathologist who discovered sulfa drugs, the first commercially available antibiotic. And Alexander Fleming, a Scottish biologist who discovered lysozyme, the first purely organic substance with antibacterial properties, and penicillin, derived from mold.

These stories, some more familiar than others, add up to a fascinating peek inside the cutting-edge laboratories of the 19th and 20th centuries, as the best and brightest minds of modern science plotted the course to the age of antibiotics. Despite their revolutionary insights, however, progress was halting. It took a full century to translate rudimentary germ theory into the routine clinical use of antibiotic drugs. Clinical successes required the discovery of naturally occurring antibacterial drugs—a discovery that launched a massive and highly competitive scouring of the planet, including its remote jungles and oceans, for the next miracle cure.

It was this ambitious and expensive enterprise that led to the emergence of the pharmaceutical industry—and over a relatively short time to the perversion of the traditional relationship between patient, physician, pharmacist, and the corporate world, including sometimes ruthless marketers and ad men.

This is the second major piece of Miracle Cure, and it’s as discouraging as the scientific quest was heroic. Many of the companies we now lump together and know as Big Pharma were originally labs—indeed some of the same labs that untangled the mysteries of human biology. Traditionally, physicians took the insights of these lab scientists, published in medical journals, and made clinical judgments, prescribing various combinations of substances that “chemists” then compounded into drugs for patients. It was an unregulated world, but one in which physicians were much more closely connected to the scientists investigating basic biology.

Today by contrast, physicians from coast to coast and beyond simply scribble amoxycillin on a pad and druggists count out the pills. The compounding—and the creative thinking—has been done elsewhere, in the factories of Big Pharma. This change has clearly had social benefits— namely efficiency and improved safety—but it has also diminished the role of the physician in the treatment of patients. What physicians know about the drugs they have learned from the pharmaceutical companies’ sales teams, who keep their eyes on the bottom line.

Rosen does not simplify this story, as I have had to do here. He tells, in compelling detail, about the transformation of modest biology laboratories into drug companies that, through a series of acquisitions and mergers, have become a $40 billion industry. Unhappily, despite its massive expansion, the industry that grew out of antibiotic discoveries no longer offers much in the way of antibiotic drugs. Many of the pharmaceutical giants—Eli Lilly, Roche, Bristol-Myers Squibb—have gotten out of the pharmaceutical business altogether.

That’s because it’s extremely difficult to find a new antibiotic any more. Almost every antibiotic readily available today uses one of very few methods to attack pathogens, and no revolutionary new ideas are appearing on the horizon. And what’s worse, the existing drugs are losing their effectiveness because bacteria are evolving over time to become resistant.

Antibiotic resistance has been recognized as a problem since at least the 1940s, when Alexander Fleming warned of resistant microbes in his Nobel Prize Lecture. It has been reported in the popular press since the ’50s. One culprit, probably the main culprit, is the medical profession itself. Though physicians should know better, they have for years been prescribing antibiotics for everything from migraines to colds, conditions for which they are entirely ineffective. As a result of this overprescription problem, there has been an increasing number of disease outbreaks caused by resistant pathogens. Rosen also points the finger at advertising: Caught up in the fierce competition for sales, pharmaceutical companies too often have employed Madison Avenue’s hard sell approach in overpromising to doctors and patients about the effectiveness of their wares.

There is no obvious answer to the problem of antibiotic resistance. And so, three-quarters of a century after Anne Miller’s dramatic recovery from a life-threatening infection in the New Haven Hospital, this once-robust enterprise is looking more and more sickly. There is a lot of blame to go around—and Rosen calls every player to account—but barring a miracle, we may be heading for a premature end to the age of antibiotics.

Wray Herbert is the author, most recently, of On Second Thought: Outsmarting Your Mind’s Hard-Wired Habits.