ABSTRACT
Prior to the 20th century, the discovery of drug substances for the treatment of human diseases was primarily a matter of “hit or miss” use in humans, based on folklore and anecdotal reports. Many, if not most, of our earliest therapeutic remedies were derived from plants or plant extracts that had been administered to sick humans (e.g., quinine from the bark of the cinchona tree for the treatment of malaria in the mid-1600s and digitalis from the foxglove plant in the mid-1700s for the treatment of heart failure, to name two). Certainly, some of these early medications were truly effective (e.g., quinine and digitalis) in the sense that we speak of effective medications today. On the other hand, based on the results of careful studies of many such preparations over the years, either in animals or man, one is forced to come to the conclusion that most likely, the majority of these plant extracts was not pharmacologically active, but rather they were perceived as effective by the patient because of the so-called placebo effect. Surprisingly, placebos (substances that are known not to be therapeutically efficacious, but that are administered so that all the psychological aspects of consuming a “medication” are presented to the patient) have been shown to exert positive effects in a wide range of disease states, attesting to the “power of suggestion” under certain circumstances. There still exist today practitioners of so-called homeopathic medicine, which is based on the administration of extremely low doses of substances with known or presumed pharmacologic activities. For example, certain poisons, such as strychnine, have been used as a “tonic” for years in various countries at doses that are not only nontoxic but that in the eyes of most scientifically trained medical and pharmacological authorities, could not possibly exert an actual therapeutic effect. Homeopathy is practiced not only in underdeveloped countries, but also in certain well-developed countries, including the United States, albeit on a very small scale. Such practices will, most likely, continue since a certain number of patients who require medical treatment have lost faith, for one reason or another, in the so-called medical establishment. More will be said about proving drug efficacy in Chapters 8 to 10.
