Health – Not a magic bullet but a powerful tool

In a way, modern medicine has become the victim of its own success. In 1907, Paul Ehrlich introduced the idea of a “magic bullet”, a drug that precisely targets a bacterium without affecting anything else in the body. The power of that idea, combined with medical progress, has encouraged us to believe that everything should be chemically treatable. We are still a long way from that, but there are good reasons why drugs are often the best option and why many patients prefer them.

Firstly, medications have usually been evaluated through a randomised controlled trial (RCT). To be considered scientifically proven, a therapy should be tested using a treatment group and a non-treatment group, allowing researchers to compare the therapy with doing nothing.

Ideally, the non-treatment group receives something that looks exactly like the drug being tested, so neither the participants nor researchers know who is receiving the active treatment until the trial ends. This reduces the influence of suggestion, known as the placebo effect.

Participants are randomly allocated to each group to create a genuine like-for-like comparison. The trial also needs enough participants to provide statistical power and must run long enough to prove or disprove whether the treatment works. Trying something on two people who then improve does not count as scientific evidence.

All this is expensive. Governments and large academic institutions undertake major trials, but drug companies carry out much of the research and development for commercial reasons. Bringing a new drug to market can cost hundreds of millions of dollars, with no guarantee of success, and can take 10 to 15 years from discovery to clinical use.

RCTs work particularly well for drugs because it is easy to produce a look-alike placebo. They are harder to apply to surgery, counselling, lifestyle changes and hands-on therapies, where patients usually know whether they are receiving the real treatment. Traditional remedies such as herbs also cannot be patented, so there is little commercial incentive to fund definitive trials.

Secondly, medications can be remarkably effective. Consider the low-dose aspirin often taken by heart patients. A 100mg pill, about one-fiftieth of a teaspoon, can survive stomach acid, be processed by the liver, travel through the body and help protect the coronary arteries. It saves thousands of lives, and it is a natural product.

Thirdly, taking pills is easy. In depression, counselling may be as effective as medication, but it can be time-consuming, difficult to access and requires effort. I strongly support counselling and refer people frequently, but some would rather take a “happy pill”.

Drugs are not a magic bullet, but they remain a powerful tool and one of the great benefits of the modern age.