Horizon (1964–…): Season 46, Episode 10 - Pill Poppers - full transcript
Over the course of your lifetime,
you're likely to be prescribed
more than 14,000 pills.
Tiny little spheres of crushed
powder with almost magical effects,
pills that will possibly save
and extend your life by decades.
Any medicine actually is a miracle.
If you really think
about what a medicine does,
that you can design a small chemical
to interfere with a biological
process to alter disease...
I mean, it is just astonishing
that you ever get there.
These miraculous pills often owe
as much to serendipity as science.
We started with a drug that we hoped
would be effective in angina
and we ended up with a medicine
that was highly effective
in erectile dysfunction.
This accidental nature of drug
discovery means little is known
about what they can do
until we all take them.
In many ways you learn
as much about your medicine after
it's launched as you knew before.
The results of this process
can be unsettling.
When you take a tablet,
you're entering into a bargain.
Our side of the deal is that
we honestly believe the tablet
will do you more good than harm,
but you have to accept the
possibility that it may, in the long
term, do you more harm than good.
We just don't know that yet.
Our relationship with pills
starts from the very
beginning of our lives,
from the medicines handed
to us by our parents.
I used to get so upset having to take
these pain killers because I didn't
want to,
so my mum, I was probably about five,
and my mum used to snap them in half
and tip the actual medication
into orange squash for me.
My mum gives me my
tablets every day.
As we grow up, we begin to pop
pills for everything.
There are the antibiotics we take
to fight off disease, more than one
course every two years of our lives.
The 28,000 pain killers we each take
to make us feel better.
Pills to stop us having babies.
I actually got pregnant on the pill.
So...
Medicines to carry
us through middle age.
Statins.
Simvastatin. Simvastatin.
Even tablets to extend our youth
and improve our performance in bed.
Yes, yes, I have used it.
The first month it came out.
By the time you're in your 70s,
you'll probably be taking
at least five tablets a day.
The pills we take define who we are.
Pills are just part
of my everyday life.
And what we are.
I take a lot of pills. Matter of
fact, I take 15 a day to keep alive.
But they're not always beneficial.
We read through the back and I
had every symptom on that packet.
How much do we really know
about the pills we take?
And can we trust them to do
what they're supposed to?
This is a temple to modern science -
the pharmaceutical labs at GSK.
But modern drug discovery
relies more on an automated lottery
than careful design.
This store of chemical compounds
is the company's crown jewels.
This is where
their new drugs come from.
In here is a library of over two
million nameless chemical compounds.
The scientists
know very little about them.
They could be highly toxic,
or they could be harbouring
a life-saving drug.
It really is trying to
find a needle in a haystack.
It is about getting the samples out,
processing them, screening them
and hoping we find that
that chemical compound
that is active
against those disease areas.
This is where the lottery begins.
A known disease molecule,
called the target,
is introduced to each of the two
million compounds, one by one,
to see if anything happens.
With the two million or so compounds,
we might get a few compounds that
are active against that target.
We then have to take that
one or two hits
and the chemists will make hundreds,
maybe thousands, of samples
related to that original structure
to try and improve the activity
and most importantly try to negate
any safety or undesirable effects.
We have to screen those
over and over again to make sure that
we're going in the right direction.
After hundreds of millions of tests,
just a handful will make it
through to trials on people.
In all, it takes about
1 billion and 15 years' work
to find the winning compound
that can become a licensed drug.
The journey to a medicine
is an epic journey.
That whole process
from idea through to a drug approved
is one littered with failure.
Despite the minute success rate,
the potential rewards are enormous.
We hope there would
be chemicals in here
that would be the future cures
for all sorts of disease areas.
It would be nice to think that here
we do have the cures for cancer,
AIDS, malaria, any of the World
Health Organisation top priorities.
If drugs are not designed
but discovered,
then it should come as no surprise
that we only find out what they
really do to us when we take them.
Give me your hand.
Give me your hand. Liam!
This is Liam.
Aged five, he was disruptive,
hyperactive and unable to focus.
Liam, there's cars coming.
Straight here now!
And this is Ed.
I've just finished my
law exams for this year.
I've got a triathlon coming up
in two days' time
and I've got a couple of jobs
on the go at the minute
so things can be quite hectic.
It does sometimes feel
like there aren't quite
enough hours in the day.
Don't, Liam!
For very different reasons,
both Ed and Liam have found
benefits from the same drug.
Aged five, Liam was diagnosed
with attention deficit
hyperactivity disorder, ADHD.
Come on, your hot chocolate's ready.
Now, five years later,
Liam's life has been transformed.
Here you go. Thank you.
One, two, three, four, five.
Excuse me.
Whose go is it next?
Mine? No it was me, you...
His newfound ability to concentrate
is largely thanks to a drug called
methylphenidate,
best known to most
of us by a brand name - Ritalin.
It takes about 30-40 minutes
for it to work,
and it's not like Liam
suddenly goes docile.
It just basically does
have a calming effect on him.
He doesn't seem to be as hyperactive
on the medication and he is able to
sit quietly,
be able to focus on things
like his homework
or just, just basically have
a more normal life, really.
And, as for thousands of other
children, Ritalin has had
a remarkable effect on Liam.
I feel calm.
I don't feel like excited.
I feel energy because I can just
run around all day if I wanted to
but I'm just calm now.
And I'm excited as well.
Now without the medication,
you could ground Liam
and he would go back the next day
and do the same thing that
he'd been grounded for.
With medication it just enables
him to consider the consequences,
a little bit more clearly,
of his actions.
It was only by accident that
researchers discovered drugs
like Ritalin
could help children with behavioural
problems concentrate better.
These drugs were originally designed
50 years ago for the treatment
of adults with depression.
It's only now we are beginning
to understand how they work.
ADHD is believed to be
caused by an imbalance
of key chemical messengers in the
areas of the brain that control
attention and working memory.
Ritalin appears to make these
messengers more effective,
helping to restore attention.
Like all drugs,
Ritalin comes with a cost.
It can cause a loss of appetite
and insomnia.
But now another benefit
has been revealed from
which we could all profit.
Initially when I took the Ritalin,
I didn't feel any difference.
Only really afterwards did I
actually notice that I felt slightly
more focused than I usually do.
I found it really difficult to
kind of get into that mental state
where I kind of felt I could
just sit and do nothing.
I found myself looking for
things to occupy my attention.
Ritalin can work
as a cognitive enhancer.
If a person without ADHD takes it,
it can make them cleverer.
It's a discovery not lost on
the country's academic elite.
Here at Cambridge University,
students are abusing Ritalin
or its close relative, modafinil,
to help them get ahead.
A few of my friends do
what they call modafi-vising.
It can keep them up for 24
hours and they can keep on going.
I think they feel pretty
shocking after it,
but if you need to do a lot of work
in a short amount of time,
then that's one way
I've heard it can be done.
People who do take Ritalin, I think
they see the benefits of it and it
does help them with their revision.
My friends that do, tend to do
pretty well but I, I like to think
that's because they're quite clever.
Ed wasn't taking
Ritalin for illicit gain.
He took it
at the behest of this woman.
Barbara Sahakian is Professor
of Clinical Neuropsychology at
Cambridge University.
She's researching what drugs
for those with ADHD can do
to the brains of the healthy.
Well, we knew that the drug worked
as a cognitive enhancer
for conditions like attention
deficit hyperactivity disorder,
but would they also work in,
in healthy people
who didn't have any problems?
Could we actually
boost cognition in somebody who was
you know functioning well?
Ed was one of her
research volunteers.
They were each given Ritalin
and put through a variety
of intelligence tests.
Not only were we able to show
an improvement in their ability
to do say a task
like spatial working memory,
but they also showed
an increased efficacy
in the neural networks in the brain
that were required
to perform that task.
Professor Sahakian found the drug
had also boosted levels of chemical
messengers in healthy brains,
increasing their
concentration levels too.
We were a bit surprised
that in healthy people
you could boost cognition.
It reveals ADHD
is not a black and white disorder.
It's a spectrum,
a spectrum we are all on.
Some people are very impulsive, other
people are not impulsive at all.
I think we all know friends of ours
who might do something that
we wouldn't do
and then it's a question
of if we go further up that spectrum,
that we may start to find somebody
who is actually not functioning
very well because their impulsive
behaviour or their lack of attention
is very bad and therefore they
do actually need a treatment.
This potential to
make us all cleverer
opens an ethical minefield.
I think it is cheating because
it's not your natural self.
If you want to do well, I feel that
should be a personal achievement
as opposed to enhanced by
artificial mechanisms.
If a lot of people took it,
then people would HAVE to take it
to be able to compete
with their peers.
To be perfectly honest, doing
what it does, if it was legal,
and it was safe,
everyone would be doing it.
Already it's being
put to use amongst professionals.
Professors are using it to help them
work, and surgeons are looking at it
as a way of staying alert
during long and complex surgery.
But for Professor Sahakian
the question remains - will it
actually make our lives better?
Suppose we took cognitive enhancing
drugs and we got all our work done in
a short period of time,
we could go home, spend time with
our family and improve our work/life
balance. That would be great.
But it's more likely with
the type of society that we
seem to be moving towards
that it will be this 24/7 society
so we'll take these drugs so we can
work longer, so we can travel more
and do more work so it will disrupt
our work/life balance even more.
I'm always looking for ways that
I can squeeze more in.
At one point I did think I'm
going to have to give up eating,
sleeping or one of my jobs.
It did cross my mind actually
that if I could get my hands
on something like that again,
it would be, you know...
maybe to my advantage.
I'm not sure about a pill that
would make you more intelligent.
We're happy being a bit...
on the thick side.
Yeah, being a bit thick's OK.
We'd like to think our drugs
are designed for exact purposes,
but they're not as targeted
as we think.
We only discover where in our
bodies they work when we take them.
It turns out Ventolin inhalers,
a treatment for asthma,
can also prevent premature labour,
and arsenic, a notorious poison,
is making a comeback as
a treatment for leukaemia.
Even the fastest-selling
drug of all time is not used
for what it was designed.
It started life as UK 92480,
one of millions of compounds in the
stores at the drug company Pfizer.
They were looking for a new drug for
angina, something that would relax
blood vessels around the heart.
After screening hundreds
of thousands of compounds,
they ended up with UK 92480.
But its trials in
humans were a let-down.
It was about to be consigned
back to the stores when
the trial volunteers
started coming back and
reporting an unusual side-effect -
lots of erections.
Add the drug the relaxation's get
larger but its trace is upside down.
By making a crude mock-up of
the human sexual apparatus,
senior scientist Chris Wayman
found an ingenious way to
test this anecdotal evidence.
These are actually
penile blood vessels
that we have in a tissue bath.
Think of this as the brain. This is
the brain and the spinal cord.
When you're becoming aroused,
your brain switches on.
We can mimic this by switching on
the equivalent of the central
nervous system in the brain.
It sends electricity down to the
tissue bath and across the tissues,
and when we pass an electric current
across these small pieces
of penile tissue, they relax
and ultimately that's what happens
during penile erection.
Relaxed penile blood vessels
mean more blood flow to the
penis, and so an erection.
What Chris did was take penile
blood vessels from impotent men,
vessels that didn't respond when he
flicked the brain switch,
and then added UK 92480
to the tissue bath.
What was most amazing about this
study was that we saw a restoration
of erectile response.
It's very rare in any tissue
preparation to convert dysfunctional
to normal function, and so now
we were really onto something that
could only be described as special.
At the time there was no oral
treatment for erectile dysfunction.
No-one even really knew
what caused the problem,
but suddenly Pfizer had a
potential treatment on their hands.
When this data was shared with
the experts in the field,
the urologists,
they were astounded.
I remember a meeting in America at
the Urological Association where
the room was packed
when this data was released because
no-one had seen anything
like this before.
UK 92480 was renamed Viagra,
and within weeks of going on sale,
tens of thousands of prescriptions
were being written every day.
You would never have been able to
predict that this was going to have
beneficial effects
on millions and millions of men
throughout the world,
a little bit of science having
effect on self-esteem, anxiety,
depression levels
and ultimately creating
enhanced relationships.
Viagra is now one of the most
prescribed drugs in the world.
Six tablets are dispensed
somewhere every second.
But some have begun to ask
whether so many men need it.
When it first came out,
it was definitely seen as a
medical drug for a chronic condition,
a medical condition,
but obviously they suddenly became
aware of a huge market capacity.
They began to market it to men who
occasionally didn't have an erection
as opposed to consistently
didn't have an erection,
and the message shifted from being,
"This is for you if you're ill with
another health problem",
to, basically,
"You can always have great sex."
Viagra wasn't the
only one to do this.
I mean, the other sex drugs
like Levitra and Cialis
that came on slightly later
all use a similar marketing strategy.
Pfizer claims more than half
of all men over 40
have difficulties getting
or maintaining an erection.
But this figure is not
universally accepted.
We estimate it's around 9% of men
who have it as a chronic condition,
and that's usually
linked to older men
and men who have got
other health problems.
In terms of men occasionally
having problems with erections,
most men would actually probably
do that and that's quite normal.
The implication is that if you're
falling short of 100% perfection,
that, you know, the pill
may be able to help
and, in essence,
this means that you're ill.
But of course being 100%
perfect is not normal.
This is not the normal state.
Being normal means being slightly
different from one day to the next.
Pfizer stands by its claim.
But this throws open the question,
what is a medical condition?
The latest target is
women with a low sex drive.
It's even got a medical term -
female sexual dysfunction.
Already the race is on between
drug companies to find a cure.
But is not wanting sex
necessarily a medical disorder?
The idea that you categorise
a problem of female sexual
dysfunction or FSD,
I think is the best example
we've ever had
of creating a market for a disease
and kind of creating a disease out
there where none existed before.
Because if you think about it,
a lot of women would say
they don't want sex very much
because they're tired
or they've got low self-esteem.
There's a joke we make which
is if you can create a pill
that would make your partner
do the housework,
it would probably be more
beneficial than giving women a drug
that would actually
boost their sex drive.
Pills and sex can be a
lucrative combination.
But sometimes drug companies are not
the first people to see that.
In the UK, one third of all
women of reproductive age
take the contraceptive pill.
Worldwide,
a hundred million rely on it,
but it almost never
reached the market.
In the 1950s, research into
contraception was illegal
in many parts of the world
and where it was legal,
pharmaceutical firms
feared a moral backlash.
Despite this,
independent researchers did discover
how to synthetically
create female hormones.
They realised giving these
to women as a pill
would change their fundamental
biology and stop them ovulating,
preventing them
from getting pregnant.
Pharmaceutical companies were
reluctant to back the project,
so when one did get behind it,
the pill was brought to the
market as a drug for heavy periods,
but women soon cottoned on
to its real potential.
It's just allowed people to manage
their fertility and their families,
and has
liberated people in that sense.
In the past, a lot of people
were stuck with families that
were getting bigger and bigger
because they just couldn't stop
babies from coming,
and really within the last
sort of 40, 50, 60 years
we've been able to manage that
and have the families of
the size that we want,
which has led to healthier children
and happier families.
The result was a social revolution.
On the male side however,
contraception hasn't changed
since rubber condoms and vasectomies
were invented in the 19th century.
Men still don't have a
pill of their own.
What's stopping it
is a question of numbers.
To produce effective
contraception for a man
by suppressing the sperm production,
you need to suppress something
like two hundred million sperm
from being produced
from the testes every day,
and that is quite a big
challenge compared to suppressing
the production of one egg
every month in a woman.
Now, after years of research,
Professor Fred Wu and his team
have found a way to prevent
so many sperm being produced,
giving men powerful sex hormones,
tinkering at the heart
of what makes a man a man.
It switches off the hormones
from the pituitary gland,
so basically the testes stop working.
It's put to sleep.
Unsurprisingly, this process
has a major side effect -
the very emasculation
of the patient.
In order to restore their manhood,
some more hormone
altering is needed.
At the same time we're
giving back the testosterone,
so that the male features
and the male characteristics
are fully preserved.
The result, in theory, is a fully
functioning man, just without sperm.
It may sound extreme,
but it's no more radical than
what millions of women endure.
But Professor Wu is finding
it hard to get the backing
of a pharmaceutical company.
It seems times have changed.
We are now more wary of meddling
with our bodies than 50 years ago.
If the female contraceptive pill
was developed from scratch now,
it would probably come across
exactly the same difficulties
as we are at the moment.
Professor Wu remains undaunted.
There is definitely a
potential market for it,
and I think once a product
like this is marketed,
it may well lead to
changes in attitudes,
social changes, similar to what
happened with the female pill
and then I think it is likely
to lead to a much larger market
than the companies
think there is at the moment.
There is one problem
Professor Wu can't solve.
When it comes to pregnancy,
the stakes will never be as high
for men as they are for women,
and with that
comes a question of trust.
I just don't think they'd do it.
I think it's something that men tend
to rely on women to do and take the
responsibility of. No offence, guys.
If you met somebody, a man,
and he just said,
"Oh, it's all right,
I take the contraceptive pill,"
I'm not sure
I'd be willing to believe that.
But then I dare say there's
some women that you can't
trust to take it.
I don't think it's just men.
Well, absolutely, yeah.
I'd probably be standing over him
watching him take it so...
They can't even put socks on
in the morning, you know,
how are they going to take
a pill at the same time every day?
Pills don't just affect our bodies.
They can treat our minds,
and sometimes finding a successful
medicine for an illness
can even change the way
we view ourselves.
Depression is a case in point.
In the 1950s, depression was
a strictly private affair.
Those that sought help
got little in return.
The few drugs that were on offer
were unlikely to lift your spirits.
You would have dry mouth,
blurred vision,
problems passing urine.
You'd feel knocked out and dopey.
It would be barely better
than the situation you were
actually in to start with.
It all changed when a new
wave of drugs came along.
Scientists had realised
that a brain chemical,
serotonin, affects our mood.
If they could find a way to boost
the amount of serotonin
in the brain,
it could improve
our sense of wellbeing.
They tested hundreds of compounds
and managed to create
a new class of drugs
that had a fraction of
the side effects of the
older anti-depressants.
This group was termed selective
serotonin re-uptake inhibitors,
SSRIs.
Soon they were known simply by
the brand name of the first
one on the market, Prozac.
Suddenly depression had
become a treatable condition,
and that
made it more socially acceptable.
If you have an effective
treatment for a condition,
people who suffer from that condition
will come out of the woodwork
and you'll find more often that,
build it and they will come.
By the 1990s, the number
of people coming forward
seeking treatment tripled.
Soon SSRIs were a
solution to everything.
Back in those days, if you came
into a GP's surgery looking
a little bit glum cos someone stole
your bike or your dog died,
you'd be assessed as being depressed
and be given anti-depressants.
Way overkill.
Everyone now admits that was true.
In time, the tide began
to turn against SSRIs.
As more and more people took them,
some disturbing serious
side effects began to emerge.
The risks are that approximately
one in five people
will become much more
anxious on these drugs,
that one in 100 or so
will go on to a suicidal act,
that one in the area of something
like 500 to 600 people
may go onto complete suicide,
who wouldn't have done so if
they hadn't been on the pills.
One drug in particular
came under scrutiny.
The makers of the controversial
anti-depressant drug Seroxat
have been criticised by the
health care regulatory body
for withholding information about
the risk of suicidal behaviour
associated with the drug.
In 2006, GSK, the makers of Seroxat,
one of these SSRIs,
admitted that Seroxat raised the
risk of suicide eight times.
Sadly, side effects from
drugs are nothing new.
Thalidomide was the great drugs
disaster of the post-war era.
Given to expectant mothers with
morning sickness in the late 1950s,
it was not long before its
devastating side effect
became clear.
It was withdrawn in 1961 and brought
with it new trials procedures
that were supposed to prevent
anything like it happening again.
But they haven't.
There are warnings that a drug used
worldwide by millions of people
with arthritis could increase the
risk of heart attacks and strokes.
Doctors have been told to stop
prescribing a drug commonly used
in the battle against obesity.
The benefits no longer
outweigh the considerable risks.
In the last five years,
in the UK alone,
eight drugs have been withdrawn
from the market by the regulators.
The anti-obesity drug,
Rimonabant,
was banned because
it could cause suicide.
Vioxx, used to treat rheumatoid
arthritis and menstrual pain,
was withdrawn after it caused
140,000 heart attacks in five years.
The discovery of undesired effects
is, however,
intrinsic to the experimental
nature of medicine.
Clinical trials are done on
thousands of people,
but some side effects are only found
when hundreds of thousands
take them,
when the drug comes to the market.
You might start picking
up side effects
that you couldn't have anticipated,
that you didn't know,
that are relatively rare
but nonetheless
can sometimes be important.
Drug development
is an ongoing clinical trial
in which we all play a part.
There's no such thing as
a totally safe medicine.
There's no such thing
as a medicine that we know
absolutely everything about
and therefore there is some
uncertainty, and that persists.
Because this goes to the heart
of what medicines are.
When you make a medicine,
you're trying to disrupt
a fundamental biological process.
That's a pretty profound change.
You can't do that without
producing some unwanted effects.
So then the question is,
what risk are you prepared
to take for what benefit.
Side effects are not restricted
to the dangers written on
the back of the packets.
For hundreds of thousands of people,
the thing that set out
to be the solution
has become the problem itself.
I'm thinking, "Oh, lovely",
then I think, "I've got
to have my tablets",
I just want this uncomfortable
feeling to start going, really.
That's all I want it to do.
These used to be my best friends.
They're not now. I hate them.
Jo Palmer
is addicted to pain killers.
It changes your personality totally.
You know ,I hated the person that
was emerging from it and I still do.
Jo's addiction started 18 years ago
when she was prescribed strong pain
killers to deal with chronic pain.
But by the time she'd been cured,
she found she couldn't function
without the drugs.
Over the years, the addiction
has taken over her life,
causing pain itself,
limiting what she can physically do.
Jo has struggled to overcome her
addiction but she can't escape it.
The problem is that she can
score her drugs on the high street.
There is quite a lot of
chemists when you look round,
and you go in and you
do it on a rota system,
so one chemist thinks that you're
just getting them once per week.
But then you drag people into it
and you don't mean to.
But you, you know, when I asked my
husband to get them for me,
he honestly said to me,
"I can't, I can't go in there
and get them for you.
"It would be like dealing to you.
You know,
"this could be the one that kills
you and I'd never forgive myself."
Jo is still battling her addiction.
The drug she craves is the codeine
in extra-strength pain killers.
Codeine is an opiate,
the same family of drugs as
class A street drug heroin.
As well as killing pain,
codeine gives a feeling of calm,
of wellbeing,
that can be more attractive
than the pain-killing itself.
It is incredibly easy
to get addicted to pain killers
and there's an epidemic,
that's not too strong a word,
of usually women out there,
who are entirely dependent on
codeine-based pain killers.
But just like any drug,
you build up tolerance and it's
this that lies behind the addiction.
The more you take,
the less effect it tends to have.
So you start out taking a small dose.
You need a bigger dose
and a bigger dose
and you finally end up
in a sort of vicious circle
where you have to keep increasing
the dose over and over,
to get the same effect
in terms of pain relief.
I was at 70 a day.
If I gave it to you, or
anybody else, it could kill you.
Me, I'm not saying it can't kill me.
I am at risk of that,
but my body has been more
used to it than you.
It's not just pain killers.
Many medicines have
the power to lure us in.
I had a situation where
I kept waking during the night
and I couldn't go back to sleep.
I tried everything I could, so
basically I went to see the doctor
and I explained to
her what the problem was.
The tablets that she prescribed me
was only a short-term thing,
six to eight weeks,
and I've been on them for about
20 years, something like that.
When I was on steroids,
when I was a lot younger,
I can always remember
looking at them thinking,
"Can I actually give them up? When
I'm in pain, what am I going
to do, what am I going to take?"
Gradually, as the years went by,
I began to realise that
I was seriously addicted
and I just needed more and more.
I couldn't get off them.
I can remember my mum tipping
them down the sink, saying,
"You can't have any more."
And once I got it in my
head that I could,
I could do without them, I was fine.
I feel great now.
I feel absolutely great.
I'm drug free.
Jo reached rock bottom in 2006
and has been trying to turn
her life around since then.
She's on the slow road to recovery,
battling against withdrawal symptoms
of nausea, pain and anxiety
if she cuts down too quickly.
I've got it under control now,
to about anything from ten
to 20 a day, on average.
Who's a good boy?!
'It's to keep off the withdrawals.'
Drop it there! Good boy!
I live day for day.
And I hope, one day,
that so many will go down
to so many, and then go down.
I don't ever give up trying.
But many people question
whether codeine even needs to be
in these over-the-counter
drugs in the first place.
One of the things about the
over-the-counter pain killers
that contain codeine with aspirin
or paracetamol or ibuprofen
is the amounts of codeine
in those tablets
is not thought to be enough to
have a real effect on the pain,
so you are probably no better off
taking those tablets
than you are taking standard aspirin,
ibuprofen or paracetamol.
They don't contain enough codeine to
give you any additional pain relief,
but there is enough
to get you hooked.
Despite how dangerous pills can be,
we still love them.
If I could invent a pill
to do anything,
I'd quite like one that could just
put you to sleep for 15 minutes
and you'd be completely
refreshed when you woke up.
I'd invent one pill
that covers the whole spectrum.
You just take one pill
in the day and that's it.
You're good to go.
If I could invent a pill,
it would be a thin pill with
no horrible side effects.
I think mine would just have to be
a general one for any very, very
severe illness that people get.
Oh, that's nice, that's so much
less selfish than me.
If I would invent any pill,
it would be something
that would cure everything
and it would be called...
..infection curer.
This love of pills
is not without good reason.
They perform miracles
on a daily basis,
none more so than antibiotics.
I believe they're magic, yes,
antibiotics.
I'm all for those.
Each of us will turn to them
an average of 60 times.
They have been credited with
increasing our lifespan
by almost a decade,
but our relationship with
nature's great miracle
is getting more fraught.
For a long time, bacteria
have been fighting back.
Dr Vanya Gant has a patient
who is battling for her life.
A treatment she's been
receiving for cancer has left
her vulnerable to infection
and now the antibiotics she's
been given aren't working.
Back in the lab,
he needs to find out why.
What I can see here
are organisms called streptococci,
because they have a classic shape
and a classic length,
and they come in chains.
But that's not really quite enough
for me to know exactly
what this bug is,
so we grow it on plates like this,
and each of these dots has about
a half-billion organisms in it.
These discs here have got antibiotics
in them which leak out into the agar,
and if you look at that one there,
you can see there's a very, very,
very, large zone of clearing
and that's because that antibiotic
is killing that organism,
but if you look at all the others,
there's no effect at all.
So this plate is telling us
that my patient has got
a highly resistant organism,
and this explains why she's not doing
quite as well as she should,
so resistant to one, two, three,
four, five antibiotics,
sensitive to only one.
Our resistance to antibiotics
is a problem that's
only getting worse.
It may be that I could show you a
plate like this in two years' time
where not only all six fail,
but the one I've got up my sleeve
and in my head that I'm going
to give her would also fail.
Organisms divide so fast,
every 15 minutes,
that within a day or two days,
there will be billions of them.
You need one to learn how to get
over the antibiotic and that's it.
It's game over.
Nature wins on this occasion.
Dr Gant has just one
final antibiotic he can try.
But he also realises that with
any antibiotic, there is a cost.
They actually make us more
vulnerable to disease.
Because bacteria also have
the power to protect us.
We would not be here
without bacteria.
We need them,
we can't live without them.
Within three hours of being born,
we have bacteria already
starting to thrive
in our intestines
and on our skin.
They make essential food for us
in our large bowel.
They make us vitamins.
The natural state of affairs that has
evolved over millions of years
is one of an exquisitely fine balance
between the bacteria that live
on and in us, and ourselves.
Antibiotics that man has made
have only been here for 70 years
and they are so powerful.
That balance can with one tablet
be completely wiped out.
Bacteria we carry with us
work alongside our immune system,
helping us fight off
nastier bacterial invaders.
But a broad-spectrum antibiotic
can't distinguish the more helpful
bacteria from the harmful.
They all get killed in the mix,
leaving you more vulnerable
to other bugs.
The thing about antibiotics is that
they're not like any other drug,
that every other drug you take
is for you and your body.
The antibiotics
are not for you at all.
They're aimed at the bugs,
and in fact,
the better the antibiotic,
the less effect it has on you.
But for Dr Gant's patient, Kathleen,
these risks are far outweighed
by their life-saving potential.
Hi there!
Hi, I've come to see
how you are today.
Well, I feel a lot better today.
Fantastic, fantastic. In what way?
I just feel more, erm, alert.
Getting back to normal,
sort of thing.
The last one Dr Gant had left
worked.
'In this lady's condition,
'she would have probably had
less than 10% chance of surviving'
had we not had an antibiotic
to treat her infection,
which is extraordinary,
and that is close to a miracle.
'We can bring people back from the
brink who would almost certainly
have died from their infection.'
Despite this success,
the question remains -
how long can this miracle
keep working?
We're entering a revolution
in medicine.
Today, pills don't just
treat illnesses we have.
There are now pills for illnesses
we may yet have,
a pill not for disease
but for the risk of disease.
Chief amongst them is a new class
of drugs known as statins.
Millions of people could benefit
from taking a drug that cuts
cholesterol levels in the blood.
New research appears to show that
a third of all heart attacks and
strokes could now be avoided.
New research into the
anti-cholesterol drugs
known as statins
offers hope
to millions of heart patients.
Statins have been heralded
as the greatest discovery
since antibiotics,
and their ability to deal with
cardiovascular disease
has made them the most prescribed
medicine in the world.
In the UK alone, six million
adults pop one every day.
Statins are fantastic drugs, no
doubt about it. They're life-savers.
We may not be sure HOW they do that
but we know that they do.
So if you take a statin,
your cholesterol level will drop.
If you take a statin, your risk of
heart attack and stroke will fall.
Statins reduce the
amount of cholesterol,
also known as lipids, in the blood.
The Government recommends
that statins be given
to all those who have had
a heart attack, a stroke or angina.
Mrs Parsons? Susan, come on in.
But now health officials are
recommending statins be prescribed
to those who are simply deemed to be
at risk of a heart attack or stroke
because their cholesterol
is raised above normal.
That means what's normal
is critical,
and the way that figure is
arrived at is causing some concerns.
'The "normal" level is one that
25-year-olds have.'
This became the "normal" level
on the basis that people with lipid
levels such as 25-year-olds have
don't go on to have a heart attack
and don't go on to have a stroke.
Setting the bar so low means most
people fall into that category.
'Almost anyone over the age of 30
will have what appears to
be raised lipid levels,
'will have what appears to be
abnormal lipid levels,'
will have a lipid level
that becomes a problem for
the doctor treating them
for which the pill is the answer.
This would not be a problem
but for the fact that statins, like
all drugs, can have side effects.
'There's a huge number of people
that go on these pills'
whose lipid levels come down
on the pills
but whose quality of life
gets worse.
They complain about muscle pain,
they complain about fatigue,
they complain about being forgetful.
They complain about a
range of different problems
that are being caused by the drugs.
You may have a choice - a shorter
life or possibly a longer one that
maybe isn't quite as much fun.
I get side effects.
You get a muscle problem
where your muscles ache
and sometimes you get cramps,
but there are benefits.
You know they, they contribute to
less strokes, for instance,
so how do you balance it out?
I don't know.
We are the guinea pigs,
without a doubt.
But it's a trade-off many more
of us may have to consider.
It has been proposed fairly recently
that all men over the age of 50
and all women over the age of 60
should be taking a statin no matter
what their cholesterol levels are
as a blanket prescription
to reduce their risk of heart
attack and stroke in future.
For some, this widening of the net
is just symptomatic of the way the
pharmaceutical industry is moving.
From about 20 years ago or so, they
moved from trying to produce drugs
that treated real illnesses to
drugs that treated risk factors.
Even those who soundly believe
in the benefits of statins are
wary of how medicine is changing.
In decades gone by, you would
be assessed by your doctor.
You'd tell him your symptoms,
he'd do the examinations,
he'd do the lab tests
and then you'd get the prescription
and only then,
whereas now the idea seems to be that
"You're alive,
you're breathing, you're 52.
"You'd better start
taking the statins to
lower your cholesterol level,
"not because it's good for YOU
but because it's good for everybody
and you are part of everybody."
Now
that must be a drug company's dream,
because if you've got a pill that's
not designed to treat sick people
but a pill that's designed for
everybody, you must be onto a winner.
What we've moved from is a world
in which we thought that
drugs were poisons
and the art of medicine was to
make sure that the person had a
reasonably serious condition
that posed risks, that justified the
risk we knew came with the pills,
to a world where the drugs
are now viewed as fertilisers.
They can do no harm if you just
sprinkle them around the place
widely.
I don't mind popping pills at all.
It doesn't bother me,
it doesn't worry me.
I think I'm being kept
alive artificially.
I think the biblical span of life
tells you that at my age,
one's usually, you know, gone.
I hate taking them, to be
quite honest, if you want the truth.
I really hate taking pills at all
because it's really against my grain
that, you know,
I'm needing to take them.
By the time you're in your 70s,
you're likely to be taking
at least five pills every day.
If it keeps me healthier
than I would otherwise be,
and hopefully mentally alert,
then, you know, it's doing its job
and thank you very much.
I believe in my heart
that it's not good.
I don't think it's a good thing.
We're not meant to take them.
In the old days, they didn't
take them. They just died, you know.
I don't like it but I... I am...
It's part of my life.
It IS my life, actually.
Millions of people turn to pills
every day to prolong their lives,
but there are some who believe
medicine could also be used to
bring it to an end, like John.
If there was such a thing as a
simple pill that you could take,
preferably with a large Scotch,
and go to sleep and not wake up,
a lot of people would prefer that,
in fact would leap at the chance.
John is a member of
Exit International,
an organisation that aims to help
people find a way to kill themselves
in a dignified way
at a time of their choosing.
I want to be able to have the choice,
when I do feel it's necessary
to take that choice,
and I don't want to leave it
either to nature
or to somebody to sort of see me
through my last few years in a
state of misery in some sort of home.
I want to be able to decide
where and when I go,
and I want other people to
have that right as well.
An overdose of anything
will be fatal.
But what many Exit members want
is a simple pill that can
end their lives in a peaceful way.
But that's not as easy as it sounds.
No pharmaceutical company
can entertain the idea,
so a bunch of octogenarians
have dug out their old high school
chemistry books
and are trying to create one,
just for themselves.
Despite spending years and
thousands of pounds on the project,
the Exit chemistry group
haven't yet created a solution.
But the search for what they
call a peaceful pill goes on.
People have asked if it's wrong
to use medicines which have
kept us alive all our lives
to bring an end to our lives.
I want us to have the choice,
and if there are medicines or methods
which we can use to do that,
with dignity above all,
then we want
the right to make that choice.
One day, the peaceful pill
could be the last of the
14,000 you may have taken,
packets and packets of pills
you've probably popped
without even thinking,
but should you be
thinking about it more?
You show me a drug with no
side effects, I'll show you
a drug with no benefits.
The difference between a drug
and a poison is basically the dose.
It was so painful, I couldn't walk
or I'd be violently sick
and I got the shivers and
my heart would race like crazy.
And I thought, "Christ, these
are just painkillers," you know.
But medicines have
the power to cure...
Oh!
..and improve the
quality of our lives.
New drugs will be discovered...
There is a huge opportunity now,
probably greater than ever before,
to make a new raft of medicines.
..and new uses found for
drugs we already have.
But there's no escaping the truth.
We're all part of
one big clinical trial.
Every patient who takes a drug
is part of an experiment
to see whether that drug is safe
to use or not in the long term.
I have spent my entire career
prescribing medicines of one sort or
another to patients of every kind.
I honestly believe that
for the majority of those patients,
we've done more good than harm.
You just have to trust him.
you're likely to be prescribed
more than 14,000 pills.
Tiny little spheres of crushed
powder with almost magical effects,
pills that will possibly save
and extend your life by decades.
Any medicine actually is a miracle.
If you really think
about what a medicine does,
that you can design a small chemical
to interfere with a biological
process to alter disease...
I mean, it is just astonishing
that you ever get there.
These miraculous pills often owe
as much to serendipity as science.
We started with a drug that we hoped
would be effective in angina
and we ended up with a medicine
that was highly effective
in erectile dysfunction.
This accidental nature of drug
discovery means little is known
about what they can do
until we all take them.
In many ways you learn
as much about your medicine after
it's launched as you knew before.
The results of this process
can be unsettling.
When you take a tablet,
you're entering into a bargain.
Our side of the deal is that
we honestly believe the tablet
will do you more good than harm,
but you have to accept the
possibility that it may, in the long
term, do you more harm than good.
We just don't know that yet.
Our relationship with pills
starts from the very
beginning of our lives,
from the medicines handed
to us by our parents.
I used to get so upset having to take
these pain killers because I didn't
want to,
so my mum, I was probably about five,
and my mum used to snap them in half
and tip the actual medication
into orange squash for me.
My mum gives me my
tablets every day.
As we grow up, we begin to pop
pills for everything.
There are the antibiotics we take
to fight off disease, more than one
course every two years of our lives.
The 28,000 pain killers we each take
to make us feel better.
Pills to stop us having babies.
I actually got pregnant on the pill.
So...
Medicines to carry
us through middle age.
Statins.
Simvastatin. Simvastatin.
Even tablets to extend our youth
and improve our performance in bed.
Yes, yes, I have used it.
The first month it came out.
By the time you're in your 70s,
you'll probably be taking
at least five tablets a day.
The pills we take define who we are.
Pills are just part
of my everyday life.
And what we are.
I take a lot of pills. Matter of
fact, I take 15 a day to keep alive.
But they're not always beneficial.
We read through the back and I
had every symptom on that packet.
How much do we really know
about the pills we take?
And can we trust them to do
what they're supposed to?
This is a temple to modern science -
the pharmaceutical labs at GSK.
But modern drug discovery
relies more on an automated lottery
than careful design.
This store of chemical compounds
is the company's crown jewels.
This is where
their new drugs come from.
In here is a library of over two
million nameless chemical compounds.
The scientists
know very little about them.
They could be highly toxic,
or they could be harbouring
a life-saving drug.
It really is trying to
find a needle in a haystack.
It is about getting the samples out,
processing them, screening them
and hoping we find that
that chemical compound
that is active
against those disease areas.
This is where the lottery begins.
A known disease molecule,
called the target,
is introduced to each of the two
million compounds, one by one,
to see if anything happens.
With the two million or so compounds,
we might get a few compounds that
are active against that target.
We then have to take that
one or two hits
and the chemists will make hundreds,
maybe thousands, of samples
related to that original structure
to try and improve the activity
and most importantly try to negate
any safety or undesirable effects.
We have to screen those
over and over again to make sure that
we're going in the right direction.
After hundreds of millions of tests,
just a handful will make it
through to trials on people.
In all, it takes about
1 billion and 15 years' work
to find the winning compound
that can become a licensed drug.
The journey to a medicine
is an epic journey.
That whole process
from idea through to a drug approved
is one littered with failure.
Despite the minute success rate,
the potential rewards are enormous.
We hope there would
be chemicals in here
that would be the future cures
for all sorts of disease areas.
It would be nice to think that here
we do have the cures for cancer,
AIDS, malaria, any of the World
Health Organisation top priorities.
If drugs are not designed
but discovered,
then it should come as no surprise
that we only find out what they
really do to us when we take them.
Give me your hand.
Give me your hand. Liam!
This is Liam.
Aged five, he was disruptive,
hyperactive and unable to focus.
Liam, there's cars coming.
Straight here now!
And this is Ed.
I've just finished my
law exams for this year.
I've got a triathlon coming up
in two days' time
and I've got a couple of jobs
on the go at the minute
so things can be quite hectic.
It does sometimes feel
like there aren't quite
enough hours in the day.
Don't, Liam!
For very different reasons,
both Ed and Liam have found
benefits from the same drug.
Aged five, Liam was diagnosed
with attention deficit
hyperactivity disorder, ADHD.
Come on, your hot chocolate's ready.
Now, five years later,
Liam's life has been transformed.
Here you go. Thank you.
One, two, three, four, five.
Excuse me.
Whose go is it next?
Mine? No it was me, you...
His newfound ability to concentrate
is largely thanks to a drug called
methylphenidate,
best known to most
of us by a brand name - Ritalin.
It takes about 30-40 minutes
for it to work,
and it's not like Liam
suddenly goes docile.
It just basically does
have a calming effect on him.
He doesn't seem to be as hyperactive
on the medication and he is able to
sit quietly,
be able to focus on things
like his homework
or just, just basically have
a more normal life, really.
And, as for thousands of other
children, Ritalin has had
a remarkable effect on Liam.
I feel calm.
I don't feel like excited.
I feel energy because I can just
run around all day if I wanted to
but I'm just calm now.
And I'm excited as well.
Now without the medication,
you could ground Liam
and he would go back the next day
and do the same thing that
he'd been grounded for.
With medication it just enables
him to consider the consequences,
a little bit more clearly,
of his actions.
It was only by accident that
researchers discovered drugs
like Ritalin
could help children with behavioural
problems concentrate better.
These drugs were originally designed
50 years ago for the treatment
of adults with depression.
It's only now we are beginning
to understand how they work.
ADHD is believed to be
caused by an imbalance
of key chemical messengers in the
areas of the brain that control
attention and working memory.
Ritalin appears to make these
messengers more effective,
helping to restore attention.
Like all drugs,
Ritalin comes with a cost.
It can cause a loss of appetite
and insomnia.
But now another benefit
has been revealed from
which we could all profit.
Initially when I took the Ritalin,
I didn't feel any difference.
Only really afterwards did I
actually notice that I felt slightly
more focused than I usually do.
I found it really difficult to
kind of get into that mental state
where I kind of felt I could
just sit and do nothing.
I found myself looking for
things to occupy my attention.
Ritalin can work
as a cognitive enhancer.
If a person without ADHD takes it,
it can make them cleverer.
It's a discovery not lost on
the country's academic elite.
Here at Cambridge University,
students are abusing Ritalin
or its close relative, modafinil,
to help them get ahead.
A few of my friends do
what they call modafi-vising.
It can keep them up for 24
hours and they can keep on going.
I think they feel pretty
shocking after it,
but if you need to do a lot of work
in a short amount of time,
then that's one way
I've heard it can be done.
People who do take Ritalin, I think
they see the benefits of it and it
does help them with their revision.
My friends that do, tend to do
pretty well but I, I like to think
that's because they're quite clever.
Ed wasn't taking
Ritalin for illicit gain.
He took it
at the behest of this woman.
Barbara Sahakian is Professor
of Clinical Neuropsychology at
Cambridge University.
She's researching what drugs
for those with ADHD can do
to the brains of the healthy.
Well, we knew that the drug worked
as a cognitive enhancer
for conditions like attention
deficit hyperactivity disorder,
but would they also work in,
in healthy people
who didn't have any problems?
Could we actually
boost cognition in somebody who was
you know functioning well?
Ed was one of her
research volunteers.
They were each given Ritalin
and put through a variety
of intelligence tests.
Not only were we able to show
an improvement in their ability
to do say a task
like spatial working memory,
but they also showed
an increased efficacy
in the neural networks in the brain
that were required
to perform that task.
Professor Sahakian found the drug
had also boosted levels of chemical
messengers in healthy brains,
increasing their
concentration levels too.
We were a bit surprised
that in healthy people
you could boost cognition.
It reveals ADHD
is not a black and white disorder.
It's a spectrum,
a spectrum we are all on.
Some people are very impulsive, other
people are not impulsive at all.
I think we all know friends of ours
who might do something that
we wouldn't do
and then it's a question
of if we go further up that spectrum,
that we may start to find somebody
who is actually not functioning
very well because their impulsive
behaviour or their lack of attention
is very bad and therefore they
do actually need a treatment.
This potential to
make us all cleverer
opens an ethical minefield.
I think it is cheating because
it's not your natural self.
If you want to do well, I feel that
should be a personal achievement
as opposed to enhanced by
artificial mechanisms.
If a lot of people took it,
then people would HAVE to take it
to be able to compete
with their peers.
To be perfectly honest, doing
what it does, if it was legal,
and it was safe,
everyone would be doing it.
Already it's being
put to use amongst professionals.
Professors are using it to help them
work, and surgeons are looking at it
as a way of staying alert
during long and complex surgery.
But for Professor Sahakian
the question remains - will it
actually make our lives better?
Suppose we took cognitive enhancing
drugs and we got all our work done in
a short period of time,
we could go home, spend time with
our family and improve our work/life
balance. That would be great.
But it's more likely with
the type of society that we
seem to be moving towards
that it will be this 24/7 society
so we'll take these drugs so we can
work longer, so we can travel more
and do more work so it will disrupt
our work/life balance even more.
I'm always looking for ways that
I can squeeze more in.
At one point I did think I'm
going to have to give up eating,
sleeping or one of my jobs.
It did cross my mind actually
that if I could get my hands
on something like that again,
it would be, you know...
maybe to my advantage.
I'm not sure about a pill that
would make you more intelligent.
We're happy being a bit...
on the thick side.
Yeah, being a bit thick's OK.
We'd like to think our drugs
are designed for exact purposes,
but they're not as targeted
as we think.
We only discover where in our
bodies they work when we take them.
It turns out Ventolin inhalers,
a treatment for asthma,
can also prevent premature labour,
and arsenic, a notorious poison,
is making a comeback as
a treatment for leukaemia.
Even the fastest-selling
drug of all time is not used
for what it was designed.
It started life as UK 92480,
one of millions of compounds in the
stores at the drug company Pfizer.
They were looking for a new drug for
angina, something that would relax
blood vessels around the heart.
After screening hundreds
of thousands of compounds,
they ended up with UK 92480.
But its trials in
humans were a let-down.
It was about to be consigned
back to the stores when
the trial volunteers
started coming back and
reporting an unusual side-effect -
lots of erections.
Add the drug the relaxation's get
larger but its trace is upside down.
By making a crude mock-up of
the human sexual apparatus,
senior scientist Chris Wayman
found an ingenious way to
test this anecdotal evidence.
These are actually
penile blood vessels
that we have in a tissue bath.
Think of this as the brain. This is
the brain and the spinal cord.
When you're becoming aroused,
your brain switches on.
We can mimic this by switching on
the equivalent of the central
nervous system in the brain.
It sends electricity down to the
tissue bath and across the tissues,
and when we pass an electric current
across these small pieces
of penile tissue, they relax
and ultimately that's what happens
during penile erection.
Relaxed penile blood vessels
mean more blood flow to the
penis, and so an erection.
What Chris did was take penile
blood vessels from impotent men,
vessels that didn't respond when he
flicked the brain switch,
and then added UK 92480
to the tissue bath.
What was most amazing about this
study was that we saw a restoration
of erectile response.
It's very rare in any tissue
preparation to convert dysfunctional
to normal function, and so now
we were really onto something that
could only be described as special.
At the time there was no oral
treatment for erectile dysfunction.
No-one even really knew
what caused the problem,
but suddenly Pfizer had a
potential treatment on their hands.
When this data was shared with
the experts in the field,
the urologists,
they were astounded.
I remember a meeting in America at
the Urological Association where
the room was packed
when this data was released because
no-one had seen anything
like this before.
UK 92480 was renamed Viagra,
and within weeks of going on sale,
tens of thousands of prescriptions
were being written every day.
You would never have been able to
predict that this was going to have
beneficial effects
on millions and millions of men
throughout the world,
a little bit of science having
effect on self-esteem, anxiety,
depression levels
and ultimately creating
enhanced relationships.
Viagra is now one of the most
prescribed drugs in the world.
Six tablets are dispensed
somewhere every second.
But some have begun to ask
whether so many men need it.
When it first came out,
it was definitely seen as a
medical drug for a chronic condition,
a medical condition,
but obviously they suddenly became
aware of a huge market capacity.
They began to market it to men who
occasionally didn't have an erection
as opposed to consistently
didn't have an erection,
and the message shifted from being,
"This is for you if you're ill with
another health problem",
to, basically,
"You can always have great sex."
Viagra wasn't the
only one to do this.
I mean, the other sex drugs
like Levitra and Cialis
that came on slightly later
all use a similar marketing strategy.
Pfizer claims more than half
of all men over 40
have difficulties getting
or maintaining an erection.
But this figure is not
universally accepted.
We estimate it's around 9% of men
who have it as a chronic condition,
and that's usually
linked to older men
and men who have got
other health problems.
In terms of men occasionally
having problems with erections,
most men would actually probably
do that and that's quite normal.
The implication is that if you're
falling short of 100% perfection,
that, you know, the pill
may be able to help
and, in essence,
this means that you're ill.
But of course being 100%
perfect is not normal.
This is not the normal state.
Being normal means being slightly
different from one day to the next.
Pfizer stands by its claim.
But this throws open the question,
what is a medical condition?
The latest target is
women with a low sex drive.
It's even got a medical term -
female sexual dysfunction.
Already the race is on between
drug companies to find a cure.
But is not wanting sex
necessarily a medical disorder?
The idea that you categorise
a problem of female sexual
dysfunction or FSD,
I think is the best example
we've ever had
of creating a market for a disease
and kind of creating a disease out
there where none existed before.
Because if you think about it,
a lot of women would say
they don't want sex very much
because they're tired
or they've got low self-esteem.
There's a joke we make which
is if you can create a pill
that would make your partner
do the housework,
it would probably be more
beneficial than giving women a drug
that would actually
boost their sex drive.
Pills and sex can be a
lucrative combination.
But sometimes drug companies are not
the first people to see that.
In the UK, one third of all
women of reproductive age
take the contraceptive pill.
Worldwide,
a hundred million rely on it,
but it almost never
reached the market.
In the 1950s, research into
contraception was illegal
in many parts of the world
and where it was legal,
pharmaceutical firms
feared a moral backlash.
Despite this,
independent researchers did discover
how to synthetically
create female hormones.
They realised giving these
to women as a pill
would change their fundamental
biology and stop them ovulating,
preventing them
from getting pregnant.
Pharmaceutical companies were
reluctant to back the project,
so when one did get behind it,
the pill was brought to the
market as a drug for heavy periods,
but women soon cottoned on
to its real potential.
It's just allowed people to manage
their fertility and their families,
and has
liberated people in that sense.
In the past, a lot of people
were stuck with families that
were getting bigger and bigger
because they just couldn't stop
babies from coming,
and really within the last
sort of 40, 50, 60 years
we've been able to manage that
and have the families of
the size that we want,
which has led to healthier children
and happier families.
The result was a social revolution.
On the male side however,
contraception hasn't changed
since rubber condoms and vasectomies
were invented in the 19th century.
Men still don't have a
pill of their own.
What's stopping it
is a question of numbers.
To produce effective
contraception for a man
by suppressing the sperm production,
you need to suppress something
like two hundred million sperm
from being produced
from the testes every day,
and that is quite a big
challenge compared to suppressing
the production of one egg
every month in a woman.
Now, after years of research,
Professor Fred Wu and his team
have found a way to prevent
so many sperm being produced,
giving men powerful sex hormones,
tinkering at the heart
of what makes a man a man.
It switches off the hormones
from the pituitary gland,
so basically the testes stop working.
It's put to sleep.
Unsurprisingly, this process
has a major side effect -
the very emasculation
of the patient.
In order to restore their manhood,
some more hormone
altering is needed.
At the same time we're
giving back the testosterone,
so that the male features
and the male characteristics
are fully preserved.
The result, in theory, is a fully
functioning man, just without sperm.
It may sound extreme,
but it's no more radical than
what millions of women endure.
But Professor Wu is finding
it hard to get the backing
of a pharmaceutical company.
It seems times have changed.
We are now more wary of meddling
with our bodies than 50 years ago.
If the female contraceptive pill
was developed from scratch now,
it would probably come across
exactly the same difficulties
as we are at the moment.
Professor Wu remains undaunted.
There is definitely a
potential market for it,
and I think once a product
like this is marketed,
it may well lead to
changes in attitudes,
social changes, similar to what
happened with the female pill
and then I think it is likely
to lead to a much larger market
than the companies
think there is at the moment.
There is one problem
Professor Wu can't solve.
When it comes to pregnancy,
the stakes will never be as high
for men as they are for women,
and with that
comes a question of trust.
I just don't think they'd do it.
I think it's something that men tend
to rely on women to do and take the
responsibility of. No offence, guys.
If you met somebody, a man,
and he just said,
"Oh, it's all right,
I take the contraceptive pill,"
I'm not sure
I'd be willing to believe that.
But then I dare say there's
some women that you can't
trust to take it.
I don't think it's just men.
Well, absolutely, yeah.
I'd probably be standing over him
watching him take it so...
They can't even put socks on
in the morning, you know,
how are they going to take
a pill at the same time every day?
Pills don't just affect our bodies.
They can treat our minds,
and sometimes finding a successful
medicine for an illness
can even change the way
we view ourselves.
Depression is a case in point.
In the 1950s, depression was
a strictly private affair.
Those that sought help
got little in return.
The few drugs that were on offer
were unlikely to lift your spirits.
You would have dry mouth,
blurred vision,
problems passing urine.
You'd feel knocked out and dopey.
It would be barely better
than the situation you were
actually in to start with.
It all changed when a new
wave of drugs came along.
Scientists had realised
that a brain chemical,
serotonin, affects our mood.
If they could find a way to boost
the amount of serotonin
in the brain,
it could improve
our sense of wellbeing.
They tested hundreds of compounds
and managed to create
a new class of drugs
that had a fraction of
the side effects of the
older anti-depressants.
This group was termed selective
serotonin re-uptake inhibitors,
SSRIs.
Soon they were known simply by
the brand name of the first
one on the market, Prozac.
Suddenly depression had
become a treatable condition,
and that
made it more socially acceptable.
If you have an effective
treatment for a condition,
people who suffer from that condition
will come out of the woodwork
and you'll find more often that,
build it and they will come.
By the 1990s, the number
of people coming forward
seeking treatment tripled.
Soon SSRIs were a
solution to everything.
Back in those days, if you came
into a GP's surgery looking
a little bit glum cos someone stole
your bike or your dog died,
you'd be assessed as being depressed
and be given anti-depressants.
Way overkill.
Everyone now admits that was true.
In time, the tide began
to turn against SSRIs.
As more and more people took them,
some disturbing serious
side effects began to emerge.
The risks are that approximately
one in five people
will become much more
anxious on these drugs,
that one in 100 or so
will go on to a suicidal act,
that one in the area of something
like 500 to 600 people
may go onto complete suicide,
who wouldn't have done so if
they hadn't been on the pills.
One drug in particular
came under scrutiny.
The makers of the controversial
anti-depressant drug Seroxat
have been criticised by the
health care regulatory body
for withholding information about
the risk of suicidal behaviour
associated with the drug.
In 2006, GSK, the makers of Seroxat,
one of these SSRIs,
admitted that Seroxat raised the
risk of suicide eight times.
Sadly, side effects from
drugs are nothing new.
Thalidomide was the great drugs
disaster of the post-war era.
Given to expectant mothers with
morning sickness in the late 1950s,
it was not long before its
devastating side effect
became clear.
It was withdrawn in 1961 and brought
with it new trials procedures
that were supposed to prevent
anything like it happening again.
But they haven't.
There are warnings that a drug used
worldwide by millions of people
with arthritis could increase the
risk of heart attacks and strokes.
Doctors have been told to stop
prescribing a drug commonly used
in the battle against obesity.
The benefits no longer
outweigh the considerable risks.
In the last five years,
in the UK alone,
eight drugs have been withdrawn
from the market by the regulators.
The anti-obesity drug,
Rimonabant,
was banned because
it could cause suicide.
Vioxx, used to treat rheumatoid
arthritis and menstrual pain,
was withdrawn after it caused
140,000 heart attacks in five years.
The discovery of undesired effects
is, however,
intrinsic to the experimental
nature of medicine.
Clinical trials are done on
thousands of people,
but some side effects are only found
when hundreds of thousands
take them,
when the drug comes to the market.
You might start picking
up side effects
that you couldn't have anticipated,
that you didn't know,
that are relatively rare
but nonetheless
can sometimes be important.
Drug development
is an ongoing clinical trial
in which we all play a part.
There's no such thing as
a totally safe medicine.
There's no such thing
as a medicine that we know
absolutely everything about
and therefore there is some
uncertainty, and that persists.
Because this goes to the heart
of what medicines are.
When you make a medicine,
you're trying to disrupt
a fundamental biological process.
That's a pretty profound change.
You can't do that without
producing some unwanted effects.
So then the question is,
what risk are you prepared
to take for what benefit.
Side effects are not restricted
to the dangers written on
the back of the packets.
For hundreds of thousands of people,
the thing that set out
to be the solution
has become the problem itself.
I'm thinking, "Oh, lovely",
then I think, "I've got
to have my tablets",
I just want this uncomfortable
feeling to start going, really.
That's all I want it to do.
These used to be my best friends.
They're not now. I hate them.
Jo Palmer
is addicted to pain killers.
It changes your personality totally.
You know ,I hated the person that
was emerging from it and I still do.
Jo's addiction started 18 years ago
when she was prescribed strong pain
killers to deal with chronic pain.
But by the time she'd been cured,
she found she couldn't function
without the drugs.
Over the years, the addiction
has taken over her life,
causing pain itself,
limiting what she can physically do.
Jo has struggled to overcome her
addiction but she can't escape it.
The problem is that she can
score her drugs on the high street.
There is quite a lot of
chemists when you look round,
and you go in and you
do it on a rota system,
so one chemist thinks that you're
just getting them once per week.
But then you drag people into it
and you don't mean to.
But you, you know, when I asked my
husband to get them for me,
he honestly said to me,
"I can't, I can't go in there
and get them for you.
"It would be like dealing to you.
You know,
"this could be the one that kills
you and I'd never forgive myself."
Jo is still battling her addiction.
The drug she craves is the codeine
in extra-strength pain killers.
Codeine is an opiate,
the same family of drugs as
class A street drug heroin.
As well as killing pain,
codeine gives a feeling of calm,
of wellbeing,
that can be more attractive
than the pain-killing itself.
It is incredibly easy
to get addicted to pain killers
and there's an epidemic,
that's not too strong a word,
of usually women out there,
who are entirely dependent on
codeine-based pain killers.
But just like any drug,
you build up tolerance and it's
this that lies behind the addiction.
The more you take,
the less effect it tends to have.
So you start out taking a small dose.
You need a bigger dose
and a bigger dose
and you finally end up
in a sort of vicious circle
where you have to keep increasing
the dose over and over,
to get the same effect
in terms of pain relief.
I was at 70 a day.
If I gave it to you, or
anybody else, it could kill you.
Me, I'm not saying it can't kill me.
I am at risk of that,
but my body has been more
used to it than you.
It's not just pain killers.
Many medicines have
the power to lure us in.
I had a situation where
I kept waking during the night
and I couldn't go back to sleep.
I tried everything I could, so
basically I went to see the doctor
and I explained to
her what the problem was.
The tablets that she prescribed me
was only a short-term thing,
six to eight weeks,
and I've been on them for about
20 years, something like that.
When I was on steroids,
when I was a lot younger,
I can always remember
looking at them thinking,
"Can I actually give them up? When
I'm in pain, what am I going
to do, what am I going to take?"
Gradually, as the years went by,
I began to realise that
I was seriously addicted
and I just needed more and more.
I couldn't get off them.
I can remember my mum tipping
them down the sink, saying,
"You can't have any more."
And once I got it in my
head that I could,
I could do without them, I was fine.
I feel great now.
I feel absolutely great.
I'm drug free.
Jo reached rock bottom in 2006
and has been trying to turn
her life around since then.
She's on the slow road to recovery,
battling against withdrawal symptoms
of nausea, pain and anxiety
if she cuts down too quickly.
I've got it under control now,
to about anything from ten
to 20 a day, on average.
Who's a good boy?!
'It's to keep off the withdrawals.'
Drop it there! Good boy!
I live day for day.
And I hope, one day,
that so many will go down
to so many, and then go down.
I don't ever give up trying.
But many people question
whether codeine even needs to be
in these over-the-counter
drugs in the first place.
One of the things about the
over-the-counter pain killers
that contain codeine with aspirin
or paracetamol or ibuprofen
is the amounts of codeine
in those tablets
is not thought to be enough to
have a real effect on the pain,
so you are probably no better off
taking those tablets
than you are taking standard aspirin,
ibuprofen or paracetamol.
They don't contain enough codeine to
give you any additional pain relief,
but there is enough
to get you hooked.
Despite how dangerous pills can be,
we still love them.
If I could invent a pill
to do anything,
I'd quite like one that could just
put you to sleep for 15 minutes
and you'd be completely
refreshed when you woke up.
I'd invent one pill
that covers the whole spectrum.
You just take one pill
in the day and that's it.
You're good to go.
If I could invent a pill,
it would be a thin pill with
no horrible side effects.
I think mine would just have to be
a general one for any very, very
severe illness that people get.
Oh, that's nice, that's so much
less selfish than me.
If I would invent any pill,
it would be something
that would cure everything
and it would be called...
..infection curer.
This love of pills
is not without good reason.
They perform miracles
on a daily basis,
none more so than antibiotics.
I believe they're magic, yes,
antibiotics.
I'm all for those.
Each of us will turn to them
an average of 60 times.
They have been credited with
increasing our lifespan
by almost a decade,
but our relationship with
nature's great miracle
is getting more fraught.
For a long time, bacteria
have been fighting back.
Dr Vanya Gant has a patient
who is battling for her life.
A treatment she's been
receiving for cancer has left
her vulnerable to infection
and now the antibiotics she's
been given aren't working.
Back in the lab,
he needs to find out why.
What I can see here
are organisms called streptococci,
because they have a classic shape
and a classic length,
and they come in chains.
But that's not really quite enough
for me to know exactly
what this bug is,
so we grow it on plates like this,
and each of these dots has about
a half-billion organisms in it.
These discs here have got antibiotics
in them which leak out into the agar,
and if you look at that one there,
you can see there's a very, very,
very, large zone of clearing
and that's because that antibiotic
is killing that organism,
but if you look at all the others,
there's no effect at all.
So this plate is telling us
that my patient has got
a highly resistant organism,
and this explains why she's not doing
quite as well as she should,
so resistant to one, two, three,
four, five antibiotics,
sensitive to only one.
Our resistance to antibiotics
is a problem that's
only getting worse.
It may be that I could show you a
plate like this in two years' time
where not only all six fail,
but the one I've got up my sleeve
and in my head that I'm going
to give her would also fail.
Organisms divide so fast,
every 15 minutes,
that within a day or two days,
there will be billions of them.
You need one to learn how to get
over the antibiotic and that's it.
It's game over.
Nature wins on this occasion.
Dr Gant has just one
final antibiotic he can try.
But he also realises that with
any antibiotic, there is a cost.
They actually make us more
vulnerable to disease.
Because bacteria also have
the power to protect us.
We would not be here
without bacteria.
We need them,
we can't live without them.
Within three hours of being born,
we have bacteria already
starting to thrive
in our intestines
and on our skin.
They make essential food for us
in our large bowel.
They make us vitamins.
The natural state of affairs that has
evolved over millions of years
is one of an exquisitely fine balance
between the bacteria that live
on and in us, and ourselves.
Antibiotics that man has made
have only been here for 70 years
and they are so powerful.
That balance can with one tablet
be completely wiped out.
Bacteria we carry with us
work alongside our immune system,
helping us fight off
nastier bacterial invaders.
But a broad-spectrum antibiotic
can't distinguish the more helpful
bacteria from the harmful.
They all get killed in the mix,
leaving you more vulnerable
to other bugs.
The thing about antibiotics is that
they're not like any other drug,
that every other drug you take
is for you and your body.
The antibiotics
are not for you at all.
They're aimed at the bugs,
and in fact,
the better the antibiotic,
the less effect it has on you.
But for Dr Gant's patient, Kathleen,
these risks are far outweighed
by their life-saving potential.
Hi there!
Hi, I've come to see
how you are today.
Well, I feel a lot better today.
Fantastic, fantastic. In what way?
I just feel more, erm, alert.
Getting back to normal,
sort of thing.
The last one Dr Gant had left
worked.
'In this lady's condition,
'she would have probably had
less than 10% chance of surviving'
had we not had an antibiotic
to treat her infection,
which is extraordinary,
and that is close to a miracle.
'We can bring people back from the
brink who would almost certainly
have died from their infection.'
Despite this success,
the question remains -
how long can this miracle
keep working?
We're entering a revolution
in medicine.
Today, pills don't just
treat illnesses we have.
There are now pills for illnesses
we may yet have,
a pill not for disease
but for the risk of disease.
Chief amongst them is a new class
of drugs known as statins.
Millions of people could benefit
from taking a drug that cuts
cholesterol levels in the blood.
New research appears to show that
a third of all heart attacks and
strokes could now be avoided.
New research into the
anti-cholesterol drugs
known as statins
offers hope
to millions of heart patients.
Statins have been heralded
as the greatest discovery
since antibiotics,
and their ability to deal with
cardiovascular disease
has made them the most prescribed
medicine in the world.
In the UK alone, six million
adults pop one every day.
Statins are fantastic drugs, no
doubt about it. They're life-savers.
We may not be sure HOW they do that
but we know that they do.
So if you take a statin,
your cholesterol level will drop.
If you take a statin, your risk of
heart attack and stroke will fall.
Statins reduce the
amount of cholesterol,
also known as lipids, in the blood.
The Government recommends
that statins be given
to all those who have had
a heart attack, a stroke or angina.
Mrs Parsons? Susan, come on in.
But now health officials are
recommending statins be prescribed
to those who are simply deemed to be
at risk of a heart attack or stroke
because their cholesterol
is raised above normal.
That means what's normal
is critical,
and the way that figure is
arrived at is causing some concerns.
'The "normal" level is one that
25-year-olds have.'
This became the "normal" level
on the basis that people with lipid
levels such as 25-year-olds have
don't go on to have a heart attack
and don't go on to have a stroke.
Setting the bar so low means most
people fall into that category.
'Almost anyone over the age of 30
will have what appears to
be raised lipid levels,
'will have what appears to be
abnormal lipid levels,'
will have a lipid level
that becomes a problem for
the doctor treating them
for which the pill is the answer.
This would not be a problem
but for the fact that statins, like
all drugs, can have side effects.
'There's a huge number of people
that go on these pills'
whose lipid levels come down
on the pills
but whose quality of life
gets worse.
They complain about muscle pain,
they complain about fatigue,
they complain about being forgetful.
They complain about a
range of different problems
that are being caused by the drugs.
You may have a choice - a shorter
life or possibly a longer one that
maybe isn't quite as much fun.
I get side effects.
You get a muscle problem
where your muscles ache
and sometimes you get cramps,
but there are benefits.
You know they, they contribute to
less strokes, for instance,
so how do you balance it out?
I don't know.
We are the guinea pigs,
without a doubt.
But it's a trade-off many more
of us may have to consider.
It has been proposed fairly recently
that all men over the age of 50
and all women over the age of 60
should be taking a statin no matter
what their cholesterol levels are
as a blanket prescription
to reduce their risk of heart
attack and stroke in future.
For some, this widening of the net
is just symptomatic of the way the
pharmaceutical industry is moving.
From about 20 years ago or so, they
moved from trying to produce drugs
that treated real illnesses to
drugs that treated risk factors.
Even those who soundly believe
in the benefits of statins are
wary of how medicine is changing.
In decades gone by, you would
be assessed by your doctor.
You'd tell him your symptoms,
he'd do the examinations,
he'd do the lab tests
and then you'd get the prescription
and only then,
whereas now the idea seems to be that
"You're alive,
you're breathing, you're 52.
"You'd better start
taking the statins to
lower your cholesterol level,
"not because it's good for YOU
but because it's good for everybody
and you are part of everybody."
Now
that must be a drug company's dream,
because if you've got a pill that's
not designed to treat sick people
but a pill that's designed for
everybody, you must be onto a winner.
What we've moved from is a world
in which we thought that
drugs were poisons
and the art of medicine was to
make sure that the person had a
reasonably serious condition
that posed risks, that justified the
risk we knew came with the pills,
to a world where the drugs
are now viewed as fertilisers.
They can do no harm if you just
sprinkle them around the place
widely.
I don't mind popping pills at all.
It doesn't bother me,
it doesn't worry me.
I think I'm being kept
alive artificially.
I think the biblical span of life
tells you that at my age,
one's usually, you know, gone.
I hate taking them, to be
quite honest, if you want the truth.
I really hate taking pills at all
because it's really against my grain
that, you know,
I'm needing to take them.
By the time you're in your 70s,
you're likely to be taking
at least five pills every day.
If it keeps me healthier
than I would otherwise be,
and hopefully mentally alert,
then, you know, it's doing its job
and thank you very much.
I believe in my heart
that it's not good.
I don't think it's a good thing.
We're not meant to take them.
In the old days, they didn't
take them. They just died, you know.
I don't like it but I... I am...
It's part of my life.
It IS my life, actually.
Millions of people turn to pills
every day to prolong their lives,
but there are some who believe
medicine could also be used to
bring it to an end, like John.
If there was such a thing as a
simple pill that you could take,
preferably with a large Scotch,
and go to sleep and not wake up,
a lot of people would prefer that,
in fact would leap at the chance.
John is a member of
Exit International,
an organisation that aims to help
people find a way to kill themselves
in a dignified way
at a time of their choosing.
I want to be able to have the choice,
when I do feel it's necessary
to take that choice,
and I don't want to leave it
either to nature
or to somebody to sort of see me
through my last few years in a
state of misery in some sort of home.
I want to be able to decide
where and when I go,
and I want other people to
have that right as well.
An overdose of anything
will be fatal.
But what many Exit members want
is a simple pill that can
end their lives in a peaceful way.
But that's not as easy as it sounds.
No pharmaceutical company
can entertain the idea,
so a bunch of octogenarians
have dug out their old high school
chemistry books
and are trying to create one,
just for themselves.
Despite spending years and
thousands of pounds on the project,
the Exit chemistry group
haven't yet created a solution.
But the search for what they
call a peaceful pill goes on.
People have asked if it's wrong
to use medicines which have
kept us alive all our lives
to bring an end to our lives.
I want us to have the choice,
and if there are medicines or methods
which we can use to do that,
with dignity above all,
then we want
the right to make that choice.
One day, the peaceful pill
could be the last of the
14,000 you may have taken,
packets and packets of pills
you've probably popped
without even thinking,
but should you be
thinking about it more?
You show me a drug with no
side effects, I'll show you
a drug with no benefits.
The difference between a drug
and a poison is basically the dose.
It was so painful, I couldn't walk
or I'd be violently sick
and I got the shivers and
my heart would race like crazy.
And I thought, "Christ, these
are just painkillers," you know.
But medicines have
the power to cure...
Oh!
..and improve the
quality of our lives.
New drugs will be discovered...
There is a huge opportunity now,
probably greater than ever before,
to make a new raft of medicines.
..and new uses found for
drugs we already have.
But there's no escaping the truth.
We're all part of
one big clinical trial.
Every patient who takes a drug
is part of an experiment
to see whether that drug is safe
to use or not in the long term.
I have spent my entire career
prescribing medicines of one sort or
another to patients of every kind.
I honestly believe that
for the majority of those patients,
we've done more good than harm.
You just have to trust him.