A story of medical innovation that does not ignore side effects


While Wells was experimenting with nitrous oxide, a dentist named William Morton was trying another anesthetic: ether. In October 1846 Morton had the opportunity to demonstrate its use in the same amphitheater in which Wells had failed. After successfully completing his operation, Morton said: “Gentlemen, this is not a joke. The amphitheater is now called the Ether Dome, in homage to the birth of anesthesia in the United States.

But that’s not the end of the story. In 1847, James Young Simpson, a Scottish physician, discovered that chloroform was more potent than ether – and also that it acted faster and did not induce vomiting. It received an enthusiastic reception in Europe. But chloroform was hardly safe, and by 1863 it was responsible for 100 deaths, often from minor operations. It wasn’t until the end of World War I that chloroform was phased out in Europe – and it wasn’t until the early 1980s that American doctors stopped using ether. Nitrous oxide continues to be used in dentistry, but contemporary anesthetics are far safer and better than anything Wells, Morton, and Simpson could have imagined.

The first heart transplant was undertaken by James Hardy, who put a chimpanzee’s heart in Boyd Rush’s chest in 1964. Rush died in just two hours. In 1967, Christiaan Barnard transplanted a human heart to Louis Washkansky, who survived for 18 days. Barnard became an international celebrity, and in 1968 more than 100 heart transplants were performed around the world. But half of the patients died within a month, and only 10 percent were alive two years later. In light of this record of failure, the number of heart transplants fell to 16 in 1970 and 17 in 1971. But Norman Shumway, Richard Lower and Richard Caves, among many others, developed a series of innovations. , including an essential immunosuppressant (now called cyclosporin) and Caves’ ‘bioptome’, a thin piano wire with a clamp at its end that could detect early when a patient was rejecting a transplant. Doctors now perform about 2,300 heart transplants per year in the United States alone. The average survival rate is 15 years.

Gerhard Domagk, a researcher at a German pharmaceutical company, aimed to kill streptococcus, one of the deadliest bacteria in the world. His work led to the production of sulfanilamide, an early antibiotic for which he won the Nobel Prize. In a short time, the drug saved thousands of lives just because of pneumonia. But it also had side effects. Diethylene glycol was found to be used as an ingredient in Elixir Sulfanilamide – and to contribute to kidney failure. As Offit explains, the sulfanilamide disaster contributed to the passage of the Food, Drugs and Cosmetics Act of 1938, which required drug companies to list all ingredients on product labels and to perform sufficient testing in advance.

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