If only we could put a healthy diet and lifestyle in a pill…

TTHE word “medication” comes from the Latin medeor or medicor, meaning to heal or to cure.

Although the Romans who spoke Latin have managed to coin the term through to this day, people were using “medications” long before they were building their empire.

We begin to understand some of the medications used for various ailments from one of the first medical texts written, The Ebers Papyrus.

Produced by the ancient Egyptians around 1500BC, it documented the use of ointments on wounds along with a plethora of herbs and minerals to treat numerous health issues.

Some of these herbs were even mixed with dough to form rudimentary pills.

All the way up until the present day, mankind has been ingesting or applying all manner of plant and animal products to themselves in order to see if their health issues can be altered, cured or prevented.

And that is the crux of a medication — essentially it is a substance used to diagnose, cure, treat or prevent disease.

Quite understandably, earlier attempts such as bathing in fragranced water to cure fevers and injecting mercury into one’s urethra to treat syphilis have had mixed results.

The trial and error methodology in creating effective medication was for a long time the best way to encourage progress in this field and, for that, we must thank our ancestors.

For example, during the 17th century, malaria was often treated with bark from the cinchona tree which contains quinine, a drug that we use to treat malaria even now (albeit in a more isolated form).

One of the driving forces behind more targeted development of medications (I often wonder how many things people tried injecting into their urethras before mercury was found to be at least partially useful) are the leaps made in our understanding of both the human body and disease as a process.

I have mentioned many times in previous articles about the long-held theory of the four humours (blood, phlegm, black bile and yellow bile) which, if imbalanced, were thought to cause disease.

Blood-letting to even out the balance was commonplace until even as recently as the early 20th century.

Only as we moved away from this and began to develop a more accurate idea of the disease processes, and the way structures within our bodies and organs worked, did we begin to phase out the more random trial-and-error approaches.

Recognition of the cellular make-up of our tissues, along with the existence of microbes as carriers of disease, were key developments that others were able to capitalise on.

Even the relatively simple observation that sailors who developed scurvy did so due to a separation from sources of vitamin C (or citrus fruits — they didn’t initially know it was specifically the vitamin contained within) prompted the introduction of medicinal limes and oranges on long ocean journeys.

While the source and origin of much of our medication emanated from the natural world, our understanding of chemistry became ever more important when it came to combining and preserving these substances in more reliable and less volatile compounds.

Then in 1843 a patent was lodged for a tablet-shaping machine that paved the way for modern industrial level production of pharmaceuticals.

Nowadays a typical tablet press can reach an output of around 1.7 million tablets per hour.

It is no surprise that the 20th century has seen such a dramatic rise in regular use of medication.

Since 1953, the World Health Organisation has recognised and named more than 10,000 medications used to treat all manner of ailments. Contraceptives, painkillers, anti-depressants, blood-thinners, anti-epileptics, anaesthetics, chemotherapy agents, steroid creams — the list goes on.

During the Seventies, WHO began listing a key set of medications that it had prioritised and highlighted as most important to address public health needs.

This list contained 208 back then but now numbers 460. Along with being chosen on the basis of their effect on the body, cost effectiveness is also a necessary factor that needs to be considered.

The global pharmaceutical industry is projected to be worth $1,170 billion by 2021.

Private pharmaceutical companies therefore drive most modern medication development and production. Once a potential drug has been identified as something useful and, significantly, something marketable, it must be put through stringent testing and trialling before it can be approved and given a licence.

Once approved, whoever developed the drug can patent it and give it a brand name. The generic name will be that of the active ingredient for the drug. For example, Viagra is a brand name for sildenafil.

Once out of patent, other manufacturers can produce the same drug and market it under its generic name, which often means its price drops significantly.

This is why a supermarket brand of ibuprofen might cost 45p compared with £2 for a branded version.

Between 2010 and 2011, the NHS spent £13 billion on medicines in England alone. This figure shot up to
£17.4 billion between 2016 and 2017.

In primary care alone, 752 million pharmaceutical items were dispensed in 2006 and this rose to 1.1billion 10 years later. Some figures suggest that around £136 million is spent by the NHS each year on prescriptions for drugs readily available over the counter.

For example, if you get a free prescription for paracetamol, it costs the NHS £3.23. Yet the same drug can be bought for as little as 19p over the counter.

We therefore encourage anyone requiring medications readily available over the counter to purchase them themselves.

It is clear that our use of medication is increasing dramatically year on year.

In 2014, half of UK women and 48 per cent of UK men regularly took prescription drugs.

Much of this is due to an ageing population but it is also a result of the increasing number of medications available to us. After all, the breadth of conditions now treatable with medication is far in excess of what we could do even 50 years ago.

Some of the most commonly prescribed and highly regarded medications used today have not been around as long as one might expect.

Beta blockers used for blood pressure, for example, were first developed in the Sixties and another form of anti-hypertensive still commonly used — ACE inhibitors — were developed in the Seventies. Statins are even younger, only becoming commonplace in the Nineties.

Having said that, it is difficult not to see a correlation between access to medicines and an increase in life expectancy or a decrease in morbidity statistics.

However, we must also be cautious. Our overuse of medication can be damaging.

Polypharmacy is the term given to the prescription of regular and multiple medications.

These all have the potential to interact with one another. Side effects are more common in these instances and we must also monitor kidney and liver functions in the blood in case the drugs are having an unseen effect, thus the need for regular medication reviews, normally on an annual basis.

Medications ingested will be excreted often by either the kidney or the liver, thus the need to ensure these organs are not being adversely affected.

Not only that, but things like antibiotics have been chronically overused since their inception.

This continues to be the case and we must all consider more responsible use of these vital medications going forward.

It should also be noted that there is a subsection of “medications” more often classed as remedies, whether they be herbal or homeopathic. These tend to be far less well regulated and sold from non-medical retailers.

Homeopathic remedies, for example, often use active ingredients so dilute as to be completely useless.

If taking any prescription medication, one should also keep in mind the potential for these to interact.

Although there is some evidence behind the placebo effect, these types of remedies are probably benefiting those selling it far more than those buying it.

If used correctly, medication is no doubt an integral and vital part of the way we practice medicine. Through an evidence-based approach, we are slowly honing the treatments we have available and will likely continue to do so.

In an ideal world though we would need no drugs at all and by far the best way to achieve this is via a healthy diet and lifestyle. If you could put that in a pill, it would be the most cost effective medication yet.

• Next time: the abdomen.