But Where Is The Medicine ?

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Headlines regularly announce the latest scientific breakthroughs which promise radical improvements in the fight against illness.

They are eye catching: DEMENTIA BUSTER New wonder drug hailed as a ‘game changer’ in battle against Alzheimer’s, or Miracle made in Britain! How the microscopic substance graphene can make sea water drinkable and even fight cancer, and from a few years ago Personal Genomes Will Spawn Made-to-Measure Drugs. But the medication that my doctor prescribes can be tens of years old and sometimes work and sometimes doesn’t. So why does it take so long for a scientific breakthrough to make its way into an effective medication ?

To get from the eureka moment in the laboratory to an effective medication is very complex. First there is the scientific discovery which establishes new facts , or explanation, that answers a question: what is the cause of cancer ?, why do cells divide ? and why is the blue print for our bodies wrapped up in something called DNA ? Once something new has been discovered it has to be turned into something that can be used. This can require developing new: skills, equipment, processes, and techniques. Finally, it has to be developed into something that people can easily use to cure, or manage, their illness.

Straddling all the stages from scientific breakthrough to medication are many regulations, intellectual property rights, industry standards, etc. some of which may require changing before the medication can be used. Then there is the tension between science and commerce where ones priorities is to discover new scientific facts and the other wants to take the breakthrough and make money from it ( the gap between the two groups is often called the ominous “valley of death” ). Many steps through layers of complexity add up to a long time and lots of money before the new medication is available for use.

To illustrate the complexities in taking a scientific breakthrough into a medicine it is interesting to trace the history of something sits on most cupboard shelves - aspirin. The story starts around 400 BC in Greece, when Hippocrates gave women willow leaf tea to relieve the pain of childbirth. It took until 1823 for the active ingredient to be extracted from willow and named salicin. Then in 1853 Salicylic acid was made from salicin by French scientists but it was found to irritate the gut. It took another 40 years until German scientists found a way to reduce its irritant properties. Then through the late 1890’s a process for synthesising aspirin was developed, clinical trials completed and aspirin was launched. The application of aspirin is still explored today, for example in the reduction of cancer risk. Today it is the best known and most widely used medicine in the world with an estimated 100 billion tablets taken every year. The history of aspirin shows how long it takes from the initial scientific breakthrough to being prescribed by a doctor, or bought of the shelf.

Digging behind the headlines shown at the beginning of this post their underlying status can be found. For the Dementia Buster claim the results are at the Phase III of clinical trials ( there are 4 phases of clinical trials) However, research into a cure for Altzhimers is notoriously difficult with success declining at each phase of clinical trials. Fingers crossed ! In the announcement of using Graphene to cure Cancer - university medical teams are working with it to produce minuscule drug delivery systems that can penetrate patients’ tumours before releasing cancer-killing medicines. However it is at the laboratory phase and a long way to go before clinical trials ! Using the Genome for personalised medicine there has been more progress. Specific genetic disorders have been been identified, for example most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two). There is also progress with gene-targeted cancer drugs and in particular helping to identify targeted cancer therapies for a wide range of cancers. Also, companies are popping up that can analyse an individuals DNA for a relatively low cost e.g. 23andMe but linking the results to medical conditions is still work in progress. Personalised, or precision, medicine continues to be a promising area of research let’s hope that it gets lots more support.

Every scientific breakthrough should be celebrated - increasing our understanding of the world and ourselves can only be a good thing. But caution needs to be applied when the breakthrough is proclaimed through media headlines - a dose of reality needs to be applied and realistic estimates given when we can get access to the new medication. Also, it will prevent embarrassing discussion with my doctor when I start “But I have read about …”.

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