More medicines that have changed our lives

crutchfieldsquareLast week this column described five advances in medicine that have enriched the quality and prolonged the lives of humankind. This week’s column features five more magnificent medicines that have changed the way we live.

 

  1. Defeating Diabetes with insulin

The lives of millions of people suffering with diabetes mellitus were dramatically changed by the discovery of this life-saving hormone. It is estimated that between 5-10 percent of the world’s population will suffer with diabetes, 90 percent of them being type 2 diabetes mellitus.

Insulin is a hormone made by the pancreas that regulates the energy sugar glucose. It works kind of like an usher, showing the glucose where to go.

High levels of glucose in the blood are very damaging to blood vessels and tissues and can have life-ending complications. Insulin ushers the glucose into the liver and fat and muscles for safe storage.

Some people are born without the ability to make appropriate amounts of insulin, which is known as type 1 diabetes mellitus. Others will either lose the ability to respond to insulin effectively later in life, lose the ability to produce the needed amount of insulin, or both. This is known as type 2 diabetes mellitus. Some women will develop diabetes during pregnancy, known as gestational diabetes, but this usually resolves after delivery.

Without insulin, glucose is not stored properly, causing high levels of blood glucose and potentially fatal consequences. In the past, the only and best treatment available was a starvation diet. In 1921, Canadian scientists Frederick Banting and Charles Best discovered that injecting ground-up pancreas extracts into dogs with diabetes kept them from dying.

After that, insulin was extracted from the pancreas of cows and pigs and used to save many diabetic lives. In the late 1970s, U.S. researchers we able to clone the human insulin gene and have it produced commercially by bacteria via genetic engineering. The use of insulin to treat diabetics has saved countless of lives.

 

  1. Propranolol: a new class of medicines to treat heart conditions

Propranolol is the groundbreaking medicine that enabled the treatment of multiple heart problems. Propranolol was the first in a class of medicines called “beta blockers.” Propranolol treats a spectrum of heart conditions including high blood pressure, irregular heartbeat problems and heart attacks.

Beta blockers “block” the action of adrenaline (epinephrine), making the heart beat less forcefully and more slowly, which can reduce blood pressure. Since propranolol’s invention, several other beta blockers have joined its ranks, many of which are superior in effect or have fewer side effects.

Nevertheless, propranolol is still widely used for blood pressure and heart conditions and is used to also treat many newer conditions, including migraine headaches, glaucoma, stage fright or anxiety attacks, and even some vascular birthmarks. The British scientist James Black developed propranolol in 1964 and in 1988 was awarded a Noble Prize in Medicine for it.

 

  1. A great visionary discovery: ivermectin

Ivermectin is a treatment for the terrible disease called “river blindness.” It has dramatically changed life for many people living in Africa.

This is the medicine of choice for treating river blindness (also known as “onchocerciasis”), caused by a parasitic worm. The worm is transmitted to humans by a bite from a black fly that lives in fast-moving water like rivers. The adult worms live under the skin in humans, but the next generation of worms move through the bloodstream and eventually end up in the eyes, where they cause blindness.

A yearly dose of ivermectin for 15 years, the lifespan of the worm, halts the disease. Over 25 million people in sub-Saharan Africa are affected. The medicine was first available in 1981.

As a result of ivermectin’s success, tens of millions of acres of rich farmland can be re-settled and used again. In the United States, ivermectin is proving to be a very effective treatment for the vexing mite infestation known as scabies.

 

  1. Clot blocker: Warfarin.

Warfarin reduces the risk of potentially fatal clots by blocking their formation and subsequent travel to other dangerous areas of the body such as the lungs. Warfarin was first discovered when certain cows would die or bleed easily and profusely after eating spoiled sweet clover. It was discovered that the spoiled sweet clover contained an ingredient that was acting as a blood clot blocker (anticoagulant).

The responsible anticoagulant compound was isolated, and a stronger derivative, warfarin, was first available in 1948 and marketed as a rodent poison. Warfarin became available to humans as an anticoagulant in 1954.

President Eisenhower was one of the early patients helped by Coumadin. Millions of people start taking warfarin every year to reduce the risk of developing a blood clot. Despite being described as a “blood thinner,” warfarin does not really “thin the blood.” It blocks the production of vitamin K (K = “klot” in German), a key ingredient in the blood-clotting process. Although very effective, it must be monitored carefully.

Interestingly, the name “warfarin” comes from its discovery at the University of Wisconsin, using the acronym for the organization that funded the key research, “WARF” (Wisconsin Alumni Research Foundation), and the ending “-arin” indicating its link with coumarin, one of the responsible components found in sweet clover.

 

  1. Parkinson’s relief: L-DOPA.

Parkinson’s disease is a degenerative condition caused by a lack of the neurotransmitter dopamine. Levodopa, also known as L-DOPA, is found in fava beans. It can be introduced into the body, cross the blood brain barrier (dopamine can’t cross the barrier), and is then converted into dopamine, replacing the dopamine lost in Parkinson’s disease.

As a result, L-DOPA helps to improve both motor and cognitive symptoms associated with Parkinson’s. L-DOPA is certainly not a cure for Parkinson’s disease, but it can significantly improve the quality of life and is a mainstay treatment in patients with Parkinson’s. Levodopa does have side effects and must be administered with caution, skill, and careful monitoring.

Next time I will discuss some of the great medicines used to treat inflammation.

 

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.