Reflections
In this book, I have chronicled eight categories of medicines. As a testament to the changing times, the old European master-apprentice relationship between drug discoverers is a thing of the past. This truth is exemplified by the feud between Selman Waksman and Albert Schatz (see chapter 2). I have no doubt that Waksman sincerely believed that he was the one responsible for the discovery of streptomycin. After all, streptomycin was the fruit of decades of his endeavor with soil microbiology in general and actinomycetes in particular. Schatz happened to be at the right place at the right time. Waksman’s conviction would have been completely acceptable if it had taken place just a century ago. Since the new millennium, vilifying the pharmaceutical industry has become fashionable. One of the crimes that the pharmaceutical industry is accused of committing involves the so-called me-too drugs. Even Merck’s former head of research Ed Scolnick once declared: “We at Merck do not do me-toos, if it is not innovative, we are not interested.” But history is replete with examples in which incremental improvements of a prototype yielded much better drugs. The first ACE inhibitor was teprotide, a peptide with nine amino acids, inspired by a Brazilian snake venom extract. Peptides did not survive in the stomach juice, which broke them down into amino acids. Therefore, the prototype teprotide could be used only by IV injection. With brilliant insight, David Cushman and Miguel Ondetti at Squibb Pharmaceuticals designed and synthesized captopril. Captopril was the first oral ACE inhibitor, which contributed tremendously to the management of hypertension. In theory, captopril is indeed a “me-too” drug to teprotide, but most patients would certainly prefer to take an oral drug than to have injections for the same purpose. Because captopril has a short duration of action, it has to be taken more than once a day. It possessed a trio of shortcomings: bone marrow suppression (due to a decrease in circulating white blood cells), skin rash, and a loss of taste.