Heroic medicine

Harmonization of pharmacopeial standards as a practical matter began at the International Congresses of Pharmacy between 1865 and 1910 [2], but the first formal attempt can be traced to 1902. Both USP President Horatio C. Wood, M.D., and Frederick M. Power, Ph.D., an American chemist of the Wellcome Chemical Research Laboratories of London, were appointed by the U.S. Secretary of State as delegates to represent the United States government at the International Conference for the Unification of the Formulae for Heroic Medicines, a conference of 19 countries from Europe and North America [3]. The second conference occurred in 1918. The 3rd in 1925 was attended by 31 countries from all continents except Asia and Australia. They drafted a new International Convention, which came in force in 1929. It revised the 1902 agreements on 77 heroic medicines and introduced the concept of maximum dose. It also requested that the League of Nations create a permanent secretariat of pharmacopeias [4]. Andrew G. DuMez, Ph.D., represented the USP, and was officially appointed by the U.S. Public Health Service to represent the United States at this conference [4,5]. An expert committee of the League of Nations planned a third conference for 1938, but it was never convened because of World War II [2]. 

Physicians more trusting of natural healing on the other hand saw heroic medicine as dangerous, even murderous. Sharpe and Faden quote the assessment of J. Marion Sims, a famous gynaecological surgeon, writing in 1835 at the time of his graduation from medical school ... 

Medicinal chemists should be aware that inexperienced biologists can erroneously conclude that poorly aqueous soluble compounds are orally absorbed when compounds are dosed in pharmaceutically unacceptable solvents. Always ask what is the dosing vehicle Heroic combinations of DMSO, Cremophor, poly(ethylene glycol), Tween-80 and ethanol are unacceptable and misleading. In case of doubt consult with a pharmaceutical scientist colleague. The reliable standards are an aqueous solution (with perhaps a trace of DMSO) or a suspension (perhaps stabilized with an acceptable quantity of adjuvant, e.g. Tween-80). 

The birth of drug discovery is closely connected to the study of plant natural products and was shaped by two seminal events, the isolation of morphine 1 from opium by the pharmacist Serturner in 18171 and the introduction in the clinics of Antipyrin 6 (phenazone) 70 years later, in 1887.2 The obtaining of a pure compound responsible for the medicinal properties of a crude drug marked the beginning of medicinal chemistry, triggering the transition from botanical extracts to pure molecules and eventually leading to the isolation of the active principle of most heroic drugs. 

For these reasons, the transition from extracts to pure compounds has been advocated since the birth of modern medicine. Thus, the eminent pharmacist Charles Louis Cadet de Gassicourt (le premier pharmacien de Napoleon) already pledged this in the inaugural issue of the Bulletin de Pharmacie in 1809112 and, thanks to the efforts of generations of phytochemists, the transition could be considered complete, at least for heroic drugs a century later. 

The phrase First do no harm, a later twist on the original Hippocratic wording, can be traced to an 1849 treatise Physician and patient by Worthington Hooker, who in turn attributed it to an earlier source (Sharpe and Faden, 1998). The background to this injunction, and its use at that point in the development of Western medicine, lay in a reaction to the heroic medidne of the early 19th century. 

Longrigg, James. Greek Medicine From the Heroic to the Hellenistic Age. New York Roudedge, 1998. 

Ochoa entered Madrid University in 1922 to study Medicine. Although he was not a student of Cajal, the famous neuroanatomist, who had retired the previous year, Ochoa in his early demonstration of enthusiasm, industry, and determination seems to have been an embodiment of the heroic young research worker , characterized by Cajal. A book that had a lasting influence on Ochoa s development was La Physiologie, Resultats, methodes, hypotheses, by the Swiss physiologist M. Arthus. 

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