From germs to genes: trends in drug therapy, 1852-2002.

Less than a decade after the founding of the American Pharmaceutical Association, the noted American physician Oliver Wendell Holmes, addressing the Massachusetts Medical Society in 1860, made his oft-quoted statement that " ...if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind-and all the worse for the fishes. " 1 The pharmaceutical armamentarium of the middle of the 19 th century was not quite so useless as the skeptic Holmes suggested. Even he qualified his condemnation by admitting that there were exceptions to his generalization, such as opium. Yet it is a striking fact that the drug therapy of the period around 1850 was in many ways more similar to that of antiquity and the Middle Ages than is is to that of the early 21 st century. As historian Charles Rosenberg has noted: " Medical therapeutics changed remarkably little in the two millennia preceding 1800. " 2 This point can be illustrated by comparing the drug therapy of today to that of the middle of the nineteenth century. A useful starting point is an examination of a list of the ten most prescribed drugs of the year 2000 in the United States and their therapeutic uses (Table I).