1. Children’s Viagra – Okay, it’s actually called Revatio, but it’s just a liquid formulation of sildenafil, the very same drug found in the famous blue pill. It’s used to treat pulmonary hypertension, a type of heart disease. (Viagra was originally developed as a cardiac drug, until researchers noticed a certain side effect.) Sorry kids, Revatio suspension is not currently available in the United States.
2. Fentanyl lollipops – What better way to calm a fussy child than with a nice lolly laced with a narcotic 100 times as potent as morphine? Actually, they’re plain white, called “lozenges” (but they’re on a stick) and they’re only approved to treat cancer pain in patients 16 years and older. Distribution is very tightly regulated, and patients must receive extensive training on keeping them locked up and out of reach of children.
3. Cocaine – Cocaine is an excellent topical anesthetic, and hospitals and dentists used to keep plenty on hand. Today, we have many similar agents without the abuse potential – some, such as lidocaine, are even sold over-the-counter. Pharmaceutical cocaine is still legal, but with all the permits, record keeping and security required, it’s seldom used in medicine.
4. Marijuana – All the debate over legalizing medical marijuana overlooks the fact that a legal, FDA-approved “marijuana pill” has been available in all 50 states for many years. Marinol (dronabinol) is a synthetic cannabinoid that works like marijuana. Put that in your pipe and...oh, never mind.
5. Warfarin – Would you like to take a drug originally used as a rat poison? It’s so effective, virtually all rodent poisons on the market today are derivatives of warfarin. Unlike prior rat poisons (think arsenic or strychnine), warfarin-like compounds kill slowly, and can be reversed by giving vitamin K, a lifesaving treatment in case of accidental ingestion. But warfarin also prevents fatal blood clots, and it’s the most widely used anticoagulant (“blood thinner”) in the world.
6. Thalidomide – Giving this drug to pregnant women to treat morning sickness became one of the most tragic mistakes in the history of medicine. Thalidomide causes severe birth defects, and horrific images of children with missing or deformed limbs led to sweeping changes in what was then a grossly inadequate drug regulation system. However, if you’re not pregnant, thalidomide is actually beneficial in some devastating diseases, such as AIDS and leprosy. It is now available to treat these conditions, with very strict oversight of prescribing and distribution.
7. Cytoxan – Even the name of this early cancer chemotherapy drug, a distant relative of World War I chemical warfare agents, sounds toxic. I imagine if it were developed today, the marketing department would name it something like “Sorbesse,” and it would have a pink logo showing a happy person surrounded by flowers. Cyclophosphamide remains a staple in cancer treatment, and it’s one of few traditional chemotherapy drugs used to treat several noncancer conditions, including kidney disease and lupus. It actually has relatively few side effects, especially at the lower doses used for non cancer conditions. I will argue all day that it’s less toxic than prednisone, which is much more widely used to treat many of the same conditions.
8. Clindamycin – In medical school, we were taught this drug was synonymous with a side effect called pseudomembranous colitis, due to a bacterium called Clostridium dificile. We were led to think it would cause near-certain doom for any patient receiving it. Actually, that side effect is rare, and can happen with any antibiotic, not just clindamycin. This drug is superbly effective against a frightening superbug, methicillin-resistant Staphylococcus aureus (MRSA for short,) which is spreading like wildfire, and is impervious to most other antibiotics. MRSA is becoming so common that clindamycin is often the first choice for treatment of skin infections. It’s also the drug of choice to treat invasive group A Streptococcus infections, better known as “flesh-eating bacteria.”
9. Phosphate supplements – For some reason, the FDA continues to churn out dire warnings about over-the-counter phosphorus supplements, as if they actually existed. Years ago, you could buy an oral sodium phosphate laxative (Fleets Phospho Soda) at any drugstore. Then some doctors began prescribing massive overdoses of it as a bowel cleanout prior to endoscopies. Many patients suffered serious effects, such as kidney failure, from this unapproved misuse of the drug. The manufacturer, fearing lawsuits, pulled it off the market, even though the problems didn’t occur when it was used as directed. Today, phosphorus supplements, even prescription forms, are almost impossible to find. Patients with certain phosphate metabolism disorders who need these drugs struggle to obtain them.
10. LSD – Lysergic acid diethylamide arguably has less toxicity, a low potential for violence, and a much lower risk of fatal overdose, compared to many common street drugs. LSD or a derivative of it might have some potential for treating post-traumatic stress disorder, other psychiatric diseases or even autism. Some studies in the 1960s showed promise, but they were not conducted using modern research techniques, so we can only view them as inconclusive. Proper research today is hindered by regulatory hurdles and the general stigma attached to the drug.
Very interesting, Rob.
ReplyDeleteFascinating facts, Rob! Thank you for sharing these in such an entertaining and informative style. I look forward to more of your thoughts!
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