The First Miracle Drugs: How the Sulfa Drugs Transformed Medicine (review)

In a 1996 issue of Caduceus: A Humanities Journal for Medicine and the Health Sciences (XII, no. 3, 1996), guest editor William G. Rothstein, asked: "When did a random patient have better than a fifty-fifty chance of benefiting from a consultation with a random physician?" John Parascandola took up the question in an article titled "Drug Therapy and the Random Patient," and argued that "effective therapeutic measures. . . did not occur until after the Second World War, let us say about the mid-1950s" (45). Had this same question been asked of author John Lesch, the answer would most definitely have been different. While the Second World War launched a therapeutic revolution with penicillin and other antibiotics, the sulfa drugs, which preceded penicillin by more than a decade, transformed the practice of modern medicine. Furthermore, Lesch views the sulfa drugs as representing "a pivotal moment in the history of twentieth-century medicine" in that they were "the culminating event of the first major phase of the industrialization of pharmaceutical innovation, and the initial event of the second great phase of that process, the therapeutic revolution that continues in our time" (5).

The author's examination of the sulfa drugs focuses on the process of innovation, and the international role of industrial research. In accomplishing this task, Lesch divides the book into three parts: the industrial origins of Prontosil and its offspring; the making of the first miracle drugs; and practice and theory.

Part I examines how bacterial chemotherapy emerged from the confluence of the bacteriological revolution with its identification of the causative agents for typhoid fever, malaria, tuberculosis, cholera, diphtheria, pneumonia, and other diseases, and the medicinal properties found in certain dyes developed in synthetic organic chemistry and used to stain tissues and cells. The discovery of chemical therapies to address microbial infections led to the rise and descent of mercurochrome as an intravenous treatment of bacterial infections, followed by Prontosil whose clinical trials opened a new era in chemical therapy. Lesch provides a window into the migration of synthetic dyes to bacterial chemotherapy and the role of the research manager in connecting the industrial research organization (Bayer/I. G. Farben) with the medical and scientific communities.

Part II illustrates the political context and institutional reception of the first sulfa drugs, the break they represented with the past, and their transitioning into medicine. Of particular interest are the challenges that I. G. Farben and its researchers faced from German antivivisectionists; the destructive nature of Germany's rising anti-Semitism, which caricatured Jews as the manipulative powers behind the chemical industry; Hitler's prohibition of any German to accept Nobel Prizes; the Nazi substitution of German folk healing, homeopathy, and organic medicine for reductionist, laboratory-based science; and the impact of the war upon the international medical community and the pharmaceutical industries. Lesch examines the differences across Germany, France, Britain, and the United States in their recognition of Prontosil, sulfanilamide, sulfapyridine, sulfathiazole, and their derivatives; their contrasting procedures for drug evaluation; their acceptance or non-acceptance of patent law; and the role of the media in creating demand.

Finally, Part III documents the large-scale government-sponsored research on the sulfa drugs that preceded America's entrance into the war and their rapid deployment in the treatment of pneumonia, gonorrhea, meningitis, bacillary dysentery, hemolytic streptococcal infections, wounds, and burns. The author also documents the early emergence and recognition of bacterial resistance, the introduction of penicillin into military medicine late in the war as a supplement rather than as a replacement to the sulfa drugs, and postwar changes in the way the sulfa drugs were used. In this final part, Lesch addresses the medical challenge begun in the mid-1940s to find the modus operandi for the sulfa drugs and how the consensus built around the antimetabolite theory, defined as "a substance that interfered with the action of an essential metabolite in a living cell," and...