10 Most Important Drugs (cont.)
10) Help for the Heart
Heart patients today owe a lot to two breakthrough drugs: Lanoxin (digoxin)
and Lasix (furosemide, also sold as Lo-Aqua).
"Digoxin makes the list, because a lot of people with heart failure would be
dead without it," Stone says.
"I had digoxin originally, but I will go with furosemide [Lasix, Lo-Aqua],
one of the first loop diuretics -- water pills -- which is still a very
important drug for hypertension and heart failure," Benet says. "Heart disease
is so important, and furosemide made a major breakthrough. We have better drugs
today, but that was the breakthrough in terms of really being effective. We have
so many drugs for congestive heart failure now, but a lot of patients can be
treated effectively with cheap diuretics."
In terms of preventing heart disease, the new cholesterol-lowering drugs
called statins promise to have a huge impact. One of the first of these drugs,
Lipitor, makes Benet's list because of its "profound impact on cholesterol
lowering."
Other experts say the statins are too new -- with too short a track record --
to put on the same list as penicillin.
More Great Drugs
Every expert who spoke with WebMD has a different list of favorite drugs.
Here are some of the notables:
- L-dopa. "When it came out it was such a wonder drug for people with
Parkinson's disease,"
Stone says. "In the latter stages, these people are completely unable to move.
But give them a shot of L-dopa and they are walking in 15-20 minutes. ... And
it is important also for confirming what we knew about the mechanisms of the
disease. ... We soon will see major advances in Parkinson's treatment. And this
is because of the initial success of L-dopa."
- Steroids. "Hydrocortisone and other corticosteroids
have an enormous range of uses any time control of inflammation and the immune
system is needed," Stone says. "There would be a lot of people with a lot of
problems if we didn't have this drug."
- Viagra. This was a controversial choice. Most experts said they couldn't
bring themselves to put Viagra or other drugs to treat sexual dysfunction
on the same list as lifesaving medicines. But Stone makes a persuasive case.
"Most people would agree a close physical relationship is fundamental to a
good quality of life. Yet there are millions of men around the world unable to
have sexual activity," he says. "It is creating a huge improvement in these
men's quality of life. It has to be on the list."
- The Capsule. Once upon a time, a doctor's
prescription came as a powder that had to be measured out and dissolved in
water or alcohol. This caused not just inconvenience but frequent errors
resulting in over- or under-doses. Then Dr. Upjohn created the gelatin
capsule. "This allowed individual dosing," Benet says. "It predates the
tablet. It is the beginning of individualization in the way we treat
patients."
- Cyclosporine. Cyclosporine is the first drug to shut
down the immune system. "With the advent of cyclosporine you have an effective
transplant drug," Benet says. "That allowed transplants to live and not be
rejected by the body."
- HIV Drugs. Benet nominates the class of HIV drugs
known as protease inhibitors. They aren't the first AIDS drugs. But by
combining protease inhibitors with other kinds of AIDS drugs, doctors found
that they could keep HIV levels so low that patients did not get AIDS. The
only reason more experts didn't vote for HIV drugs is that they're saving a
place on the list for the still-undiscovered drug that actually cures AIDS.
- Ritalin. Greenberg votes for Ritalin as the drug that showed
millions of kids with ADHD could have normal childhoods.
What's the next blockbuster drug lurking just beyond the horizon? We'll have
to wait and see. But Swann says it's important to support the system that makes
new medical breakthroughs possible.
"I hope that people appreciate that the source for new drugs has come, and
will continue to come, from a variety of sources," he says. "You have to have
support for basic science, or the pipeline will dry up. And there has to be
applied work for the phenomenon to continue as it has. All estates of science
have an important role. The universities have a crucial role, as do
pharmaceutical companies and government, too, to provide support for these
organizations that support discovery."
Published Aug. 30, 2004.
SOURCES: Trevor Stone, DSc, head of pharmacology, University of Glasgow,
Scotland; author of Pills, Potions and Poisons: How Drugs Work. Leslie Z. Benet,
PhD, professor and former chairman of biopharmaceutical science and
pharmaceutical chemistry, University of California, San Francisco; founding
president, American Association of Pharmaceutical Scientists (AAPS). Stephen
Greenberg, PhD, history of medicine division, National Library of Medicine,
National Institutes of Health, Bethesda, Md. John Swann, PhD, historian, FDA,
Rockville, Md.
© 2004
WebMD Inc. All rights reserved.
Last Editorial Review: 6/29/2005
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