Yesterday I read a fascinating (to me, anyway) article about the history of the development of drugs to treat hypertension (high blood pressure). The topic is interesting to me because a couple of months ago, my blood pressure inexplicably went from “Too high” to “Be prepared to die”. For just over a month now, I’ve been seeing the doctor often, sometimes as often as twice a week. He added a medication to the one I was already taking, desperately trying to get the BP back down. As of the last visit two weeks ago, it’s back down to “Too high”. We still aren’t finished experimenting–he may add a third drug, or a combination of a different two drugs. The silver lining to this is twofold: first, he’s very positive and says it CAN be done. Second, he’s paying attention, which is an increasingly hard quality to find in a doctor.
So with my own personal troubles, it’s no wonder I was interested in an article in the New York Times that came out on Thanksgiving Day, called The Evidence Gap: A Big Hypertension Study and Its Minimal Impact. http://www.nytimes.com/2008/11/28/business/28govtest.html?pagewanted=1&_r=1&hp The study in question purportedly showed that the very cheapest (and first discovered) drugs to treat hypertension–namely, diuretics–were as good or better than some of the more recent, more expensive, and seriously hyped-by-the-drug-companies drugs. So in one corner you have a government study whose noble goal is to save people money, and in the other corner you have the greedy drug companies with millions of dollars at their disposal to influence doctors and advertise to the general public. Not so fast. Money and politics influenced the outcome, according to people on both sides. (Surprise!) Everybody had an agenda. And perhaps out of character, I’m on the side of the drug companies on this one. Diuretics alone may do a lot of good for a large number of people, especially in the case of people who don’t have insurance, but they’re going to leave a lot of people in the dust–as the government absolutely has to know. The newer drugs have many additional benefits, but the issue here for the government, in my opinion, was more about allocation of resources, not about saving individual lives. No wonder this article was in the Business section rather than the Health section.
So I decided to do a little more research and found this truly fascinating article (The NYT article does not qualify as “fascinating”). http://www.fasebj.org/cgi/content/full/18/3/421e This article talks about the history of the development of drugs to treat hypertension and among the many interesting factoids: There were no treatments for hypertension until the 1950’s. As I mentioned earlier, diuretics were the first. Then came ACE inhibitors. The process of developing ACE inhibitors began when someone discovered that Brazilian pit viper bites were killing workers in the banana groves of South America by causing a drastic drop in blood pressure. Someone said, Hmmm…maybe we can use this to our advantage.
It seems the discovery of new drugs is often like this. It happens by accident, sort of. After the discovery of the effect, researchers then have to figure out the how. Then figure out how to make it into a drug. In its experimental stage, scientists were injecting people with pit viper venom. These days, ACE inhibitors are made synthetically, which, sadly, means that a lot of Brazilian pit vipers will now live long and healthy lives.