The Inside Story of Medicines: A Symposium

The making and prescribing of medicines, from the remote past to the near future, received brilliant summary from an all-star cast of scholars speaking at the Carter Center in Atlanta in March 1996. The symposium accompanied the opening at the nearby Fernbank Museum of a traveling exhibit on the same theme; both projects were arranged by Michael R. Harris and financed by Glaxo Wellcome Inc. The nineteen documented texts, some illustrated, are divided into four sections. The editors provide brief section introductions; editor Gregory Higby chaired the symposium and gave concluding remarks.

In the inaugural address, C. Everett Koop reviews changes in pharmaceutical discovery during his own life, stresses the importance of historical knowledge in guiding the future, and poses questions that must be wrestled with if the best progress is to be made. In the section on the history of therapeutics, John M. Riddle cites laxatives to reveal the linkages between ancient and modern times; J. Worth Estes illuminates the therapeutic crisis of the eighteenth century; and Guenter B. Risse probes shifts in physicians’ views of therapeutic strategy prior to the twentieth century.

In the section on case studies of drug discovery, John Parascandola gives examples of systematic drug study prior to World War I; Michael Bliss revisits insulin; John E. Lesch describes sulfapyridine; Robert M. Kaiser addresses the thiazides; and Caroline Jean Acker sorts out planning and serendipity in the quest for a nonaddictive opiate analgesic. In the next section, respecting the disciplines involved in medicine-making during recent times, with glances toward the future, Varro E. Tyler reviews pharmacognosy; George A. Condouris explores pharmacology; John A. Montgomery analyzes medicinal chemistry; George Zografi probes pharmaceutics; and Mark Parascandola evaluates clinical testing.

The final section addresses aspects of the marketing of medicines and their use by patients. Louis Lasagna sums up the pharmaceutical industry’s valuable role and describes threats to its stability; John P. Swann traces the deep roots of the Food and Drug Administration’s efforts to ensure the effectiveness of new drugs entering the marketplace; Mickey Smith describes the evolving interrelationship of the four P’s of marketing: product, price, place, and promotion; Paul L. Ranelli points to problems that may diminish therapeutic success in the physician-pharmacist-patient relationship; and William H. Foege provides a perceptive overview of the global impact of medicines.

It is a safe assumption that anyone, no matter how sophisticated, who is interested in the history of therapy or in the current health system—from treating patients to assaying commercial and political structures—will finish reading this rich symposium with knowledge deepened and perspective broadened.