I’ve been procrastinating on writing this article for many a month, and the longer I sit on it (or it sits on my mind), the more lethargic I feel, lethargy that spills into everything else.
So anyway, evolution is one of my most obsessive topics in science, and I spend more time thinking/reading about it than any other thought seed. Recently, after watching a TED talk about the future of evolution (people who are too sensitive to the whole eugenics business and feel their heart stabbed with even the hint of “controlling” evolution can conveniently stop reading at this point and return to their routine without bothering with the above-linked video), there was something mentioned in it that irrelevantly ignited my interest in pharmacology. In essence, after much thought, the idea boils down to this: you don’t need to meddle with genes in order to have a conscious influence on our species’ evolution; we are already doing it – in the form of medical interventions of all kinds, especially those that delay fatality.
Up until a few hundred or a few thousand years ago, man was completely subject to the will of nature, physiologically speaking. Any harmful genes and genes that would decrease the probability of survival of an individual – example, diseases acquired through hereditary, genes influencing moronic behaviors that lead to death, etc. – were all eliminated from the human gene pool through the death of the individual if the death occurred before breeding. What we define as harmful in this context need not necessarily be something extreme like cancer or plague but even a mild infection that could lead to gangrene and eventually death, or an infection during a simple fever (which is a time when the immune system is fighting to normalize body temperature and any secondary sources of malice, even something as inconsequential as a dog bite or bruised infection, would not be sufficiently dealt with by the busy immune system and thus increase chances of death). So there need not necessarily be something wrong directly with the genes themselves; the body’s immune system, which is a manifestation of those genes, can instead be easily influenced by external agents, and thus also the chances of carrying on of those genes into the next generation; or, death could not even have been from a physiologic dysfunction but rather from being eaten by a predator or death by stupidity, all of which are again manifestations of survival instincts influenced by genes. Evolution has its fingers in every pie. In as many cases as not, death used to occur well before breeding, and therefore, those genes were eliminated from the gene pool through evolutionary natural selection – a phenomenon powered by the thin line that separates death and survival.**
However, with the institution of medical science that has been gradually increasing in depth over the past couple of millennia, we have been actively delaying death and getting better at it, thereby being able to reproduce before death (not that there’s something called ‘reproduce after death,’ but you get the point) and pass on every kind of gene, good or bad, to the offsprings, and they to theirs. The larger-perspective consequence of this medical intervention simply means that we are keeping natural selection from acting on those undesirable genes and ensuring that they are kept active/present in the human gene pool. As a quick illustration of this effect, two graphs demonstrate the average life expectancy of an individual over the past few centuries and the infant mortality rate for the 20th century, both of which show that medical intervention has increased the chances of gene survival in the gene pool:
(Remember, though, that death can occur even after infancy but before reproduction - the so called "virgin deaths," for lack of a better term - so the graphs are valid yet unavailable for that demographic as well)
The conclusion here is that we are not at the mercy of nature anymore to survive, and even without actually manipulating the genes directly, we are still consciously influencing their presence in our species. Since genes are what determine the course of evolution, we humans have already begun to control the future of our species on an evolutionary scale (you could also argue that veterinary science has done the same for animals, although to a lesser degree). And in addition to delaying death and ensuring reproduction, medical intervention also treats or cures inherited/congenital and other diseases arising from those genes or from external agents, which, as I said earlier, are again manifestations of genes.
The above-linked video discusses working directly on the genes themselves and manipulating them consciously, and not indirectly through medical science as I just described, to eliminate harmful genes altogether and tune our mortality, but that is not what I want to talk about here. I am more interested in how medical science has indirectly worked on our genes and helped you and I come into existence and stay in existence.
The following are five of the most important and impressive pharmacological miracles which either we owe our existence to or which humankind is much, much worse off without. I say humankind as a collective term, of course. Individually, we all have, or will have later in life, a medicine which is as important to us personally as these are to mankind as a whole.
1. Penicillin.
The granddaddy of all modern antibiotics and the first antibiotic ever discovered. It is estimated that 75% of today’s world population would not be alive if penicillin hadn’t saved our ancestors from infections. 75% of our current population would never have known what it means “to live.” Penicillin, more than any other single factor, led to the exponential rise in population in the 20th century. We are currently developing resistance to penicillin and gradually making it ineffective on several bacterial infections, but secondary antibiotics derived from penicillin and many other antibiotics discovered even today through the same method Dr. Fleming used to (accidentally) discover penicillin in 1928 are rising up to fill the grandmaster’s place.
2. Ether
What we generally call anesthesia, was discovered in 1842. All surgeries performed until then were live surgeries, with the patient conscious. If a mass had to be removed, you had to be cut open when you could feel every moment of the excruciating pain, many dying of the pain itself. Not that we are here and alive because of this chemical compound, but without it, the millions of surgeries taking place every year would either never take place because of the fear of pain, or be so painful as to suck the life force out of you. In the awe-inspiring HBO TV mini-series John Adams, set in 18th century, one of his daughters undergoes a breast removal for a diagnosis of malignant, cancerous tumor – while she is still awake and feeling every inch of the pain as the blade cuts her breast off, and as Mr. and Mrs. Adams cry in each other's arms at the screams of their daughter's agony during the procedure. The cancer recurs in the other breast a while after, and she refuses surgery and accepts death.
3. Smallpox vaccine
The first successful vaccine in medical history, it symbolizes man’s ascendancy over the dark side of nature, a symbol in the form of a healed lesion on your left shoulder. Small pox has been one of the deadliest epidemics in recorded time – notorious not just for its mortality rates but also for the stretch of time it lurked in our species, spanning over 12,000 years. Even the Spanish flu, which claimed over 50 million lives in early 20th century, did not last longer than a few years. This vaccine used to treat the smallpox virus is ironically made of another virus – cowpox virus. Classic case of fight fire with fire, huh?
4. Antidepressants
There is a very sick mentality among the general population of judging people who are on antidepressants. I once very briefly worked on a psychiatry department account and had a long stint with general physician consulting in my line of work. I could never cease to be surprised at the number of patients with a very chronic case of depression who refused to go on antidepressants simply because of the fear of what their friends might think (I am not exaggerating. I’m barely even paraphrasing). What other people might think! I don’t think the patient is completely at fault here, because as Col. Walter Kurtz rightly put it, “It’s judgment that defeats us.” We are all inherently afraid of being judged, and that fear surfaces in these depressed patients at the sound of being on a drug for the mind, emotionally helpless as they already are. But what sickens me to my gut is when I see or hear someone judging, either vocally or with subtle facial expressions through which they so wonderfully communicate condescension, a person who is on antidepressants. No one judges patients with diabetes, heart diseases, renal failure, or any other physiological issues, but when it comes to a psychological issue, an emphatic “OH!” ensues. Right, here is the truth: clinical depression is neither a choice nor a reflection of the state of lives of people suffering from it. It’s as physiological a condition as osteoarthritis or congestive heart failure. Chronically depressed patients’ brains are physically incapable of producing the appropriate amounts of chemicals required to be happy. The only way to treat it is to fight it with an antidepressant drug, the way you would treat a backache with ibuprofen – i.e., with medicine! You can't (read slowly: CAN'T) cure it by thinking optimistically, thinking happy thoughts, taking a freakin break, or any other pop culture bullshit worthless advices people give. Go watch this enlightening Stanford video, educate your ignorant, harebrained ass, and refrain from making any smartass judgment calls the next time you hear someone is on an antidepressant: you could potentially save them their lives, just by being a decent human being. Too much to ask?
As Maria Bustillos, studying the reason for DFW's suicide, wrote the most sensible words I've ever heard from a lay person:
On a similar note, as much as I admire and appreciate Sir Ken Robinson’s intricate critique of the current state of our pathetic school/education systems worldwide, a glimpse of the judgmental attitude towards psychogenic drugs can be seen in these two (1, 2) million-plus-views Youtube videos of his. In the second video although he correctly admits that he is not qualified to comment on ADHD, he somehow believes he is qualified to comment on ADHD drugs. The very least bit of qualification required to comment on this class of drugs is to try one. But without knowing what it feels like to be on one, without conducting proper research into the drug, and without knowing what the drug does inside the brain, Sir Ken confidently posits that psychostimulant ADHD drugs numb your senses and enable you to focus on the “boring” subject by disabling you from attaining the heightened state of enjoyment you feel while watching a work of art. But the reality of it is hilariously contrary – ADHD medications heighten, NOT numb, your senses and therefore enable you to focus on whatever it is you want to focus on, including art. As someone who has tried modafinil, I can vouch for it, and so can academic sources and millions of others on it. Just try watching a film while on modafinil, and you’ll bet your life savings you are enjoying it better than Sir Ken. So making daft statements like these shows not just how uneducated (no pun intended) and biased he is against the science of mind and drugs, but also displays the stupidity of the audience that nods its heads and shares his judgment of ADHD drugs and of those who prescribe or support it. Another sad example comes from Doug Stanhope, one of my favorite and extremely bright comedians. As I said, I love both Robinson and Stanhope in all other respects but fall short of sympathizing with their disdain and judgment towards psych drugs. And all this is just a glimpse; the bigger picture is much uglier.
[I’m sorry about the tone of these two paragraphs above. I vent bitterly because I too was on an anxiolytic for a brief period last year, and save a few friends, pretty much everyone else gave me a judgmental look for it and it wasn’t too long before I realized this was a universal phenomenon that’s causing millions of people around the world to commit suicide simply because they’d rather deal with the consequence of not being treated for their psychological condition than be judged for accepting treatment.]
5. Antihypertensives
Approximately 1 billion people in the world currently suffer from hypertension (high blood pressure), and it is estimated that one out of every four people born will develop severe, chronic hypertension into their adulthood, and another one of those four will develop moderate hypertension (hypertension classification here). Hypertension has been academically called a “silent killer” because the symptoms of hypertension are so mild and unfelt over a long time that you become adjusted to its abnormality as normalcy and it slowly begins to eat away your longevity. One day, thud! Hypertension in rare cases can occur even at young age but normally occurs well into your adulthood, so antihypertensives are drugs that extend your days, and not (just) help you survive till you give birth. Many of us owe our parents’ and grandparents’ long life to this class of drugs.
Of course, utterly needless to say, every class of drugs is important, not just the ones I have chosen to mention here. From nutritionals to antivirals, NSAIDs to antipyretics, analgesics (very commonly used) to ACE inhibitors, insulin to even birth control pills and emergency contraceptive pills – sometimes not just to restore normalcy but to elevate normalcy up to higher standards of healthy living. Some are personally more important to us than any of these drugs mentioned above. But we all need them. Even those who prefer Ayurveda, Homeopathic and other alternative medicines and show a general sense of disdain towards Western medicine owe their existence to them, deny as they might. Pharmacology and medical science is what makes living today better than living in the past – more so than any other perks of human development.
____________
** (It's also worth noting that the death before reproduction of a single member of a species containing an undesirable gene isn't necessarily going to eliminate that gene from the gene pool. The individual's siblings, their chances of having inherited the same undesirable gene from the common parent, and other members of the species possessing the same gene - all influence how long a gene survives in the system, which is why undesirable genes tend to survive for several generations.)
____________
I have some thoughts on how wealth affects genes and the human gene pool from an evolutionary perspective, but they are still raw, disorganized and incomplete, so hopefully by next year I can write a blog post about it.
Up until a few hundred or a few thousand years ago, man was completely subject to the will of nature, physiologically speaking. Any harmful genes and genes that would decrease the probability of survival of an individual – example, diseases acquired through hereditary, genes influencing moronic behaviors that lead to death, etc. – were all eliminated from the human gene pool through the death of the individual if the death occurred before breeding. What we define as harmful in this context need not necessarily be something extreme like cancer or plague but even a mild infection that could lead to gangrene and eventually death, or an infection during a simple fever (which is a time when the immune system is fighting to normalize body temperature and any secondary sources of malice, even something as inconsequential as a dog bite or bruised infection, would not be sufficiently dealt with by the busy immune system and thus increase chances of death). So there need not necessarily be something wrong directly with the genes themselves; the body’s immune system, which is a manifestation of those genes, can instead be easily influenced by external agents, and thus also the chances of carrying on of those genes into the next generation; or, death could not even have been from a physiologic dysfunction but rather from being eaten by a predator or death by stupidity, all of which are again manifestations of survival instincts influenced by genes. Evolution has its fingers in every pie. In as many cases as not, death used to occur well before breeding, and therefore, those genes were eliminated from the gene pool through evolutionary natural selection – a phenomenon powered by the thin line that separates death and survival.**
However, with the institution of medical science that has been gradually increasing in depth over the past couple of millennia, we have been actively delaying death and getting better at it, thereby being able to reproduce before death (not that there’s something called ‘reproduce after death,’ but you get the point) and pass on every kind of gene, good or bad, to the offsprings, and they to theirs. The larger-perspective consequence of this medical intervention simply means that we are keeping natural selection from acting on those undesirable genes and ensuring that they are kept active/present in the human gene pool. As a quick illustration of this effect, two graphs demonstrate the average life expectancy of an individual over the past few centuries and the infant mortality rate for the 20th century, both of which show that medical intervention has increased the chances of gene survival in the gene pool:
(Remember, though, that death can occur even after infancy but before reproduction - the so called "virgin deaths," for lack of a better term - so the graphs are valid yet unavailable for that demographic as well)
The conclusion here is that we are not at the mercy of nature anymore to survive, and even without actually manipulating the genes directly, we are still consciously influencing their presence in our species. Since genes are what determine the course of evolution, we humans have already begun to control the future of our species on an evolutionary scale (you could also argue that veterinary science has done the same for animals, although to a lesser degree). And in addition to delaying death and ensuring reproduction, medical intervention also treats or cures inherited/congenital and other diseases arising from those genes or from external agents, which, as I said earlier, are again manifestations of genes.
The above-linked video discusses working directly on the genes themselves and manipulating them consciously, and not indirectly through medical science as I just described, to eliminate harmful genes altogether and tune our mortality, but that is not what I want to talk about here. I am more interested in how medical science has indirectly worked on our genes and helped you and I come into existence and stay in existence.
The following are five of the most important and impressive pharmacological miracles which either we owe our existence to or which humankind is much, much worse off without. I say humankind as a collective term, of course. Individually, we all have, or will have later in life, a medicine which is as important to us personally as these are to mankind as a whole.
1. Penicillin.
The granddaddy of all modern antibiotics and the first antibiotic ever discovered. It is estimated that 75% of today’s world population would not be alive if penicillin hadn’t saved our ancestors from infections. 75% of our current population would never have known what it means “to live.” Penicillin, more than any other single factor, led to the exponential rise in population in the 20th century. We are currently developing resistance to penicillin and gradually making it ineffective on several bacterial infections, but secondary antibiotics derived from penicillin and many other antibiotics discovered even today through the same method Dr. Fleming used to (accidentally) discover penicillin in 1928 are rising up to fill the grandmaster’s place.
2. Ether
What we generally call anesthesia, was discovered in 1842. All surgeries performed until then were live surgeries, with the patient conscious. If a mass had to be removed, you had to be cut open when you could feel every moment of the excruciating pain, many dying of the pain itself. Not that we are here and alive because of this chemical compound, but without it, the millions of surgeries taking place every year would either never take place because of the fear of pain, or be so painful as to suck the life force out of you. In the awe-inspiring HBO TV mini-series John Adams, set in 18th century, one of his daughters undergoes a breast removal for a diagnosis of malignant, cancerous tumor – while she is still awake and feeling every inch of the pain as the blade cuts her breast off, and as Mr. and Mrs. Adams cry in each other's arms at the screams of their daughter's agony during the procedure. The cancer recurs in the other breast a while after, and she refuses surgery and accepts death.
3. Smallpox vaccine
The first successful vaccine in medical history, it symbolizes man’s ascendancy over the dark side of nature, a symbol in the form of a healed lesion on your left shoulder. Small pox has been one of the deadliest epidemics in recorded time – notorious not just for its mortality rates but also for the stretch of time it lurked in our species, spanning over 12,000 years. Even the Spanish flu, which claimed over 50 million lives in early 20th century, did not last longer than a few years. This vaccine used to treat the smallpox virus is ironically made of another virus – cowpox virus. Classic case of fight fire with fire, huh?4. Antidepressants
There is a very sick mentality among the general population of judging people who are on antidepressants. I once very briefly worked on a psychiatry department account and had a long stint with general physician consulting in my line of work. I could never cease to be surprised at the number of patients with a very chronic case of depression who refused to go on antidepressants simply because of the fear of what their friends might think (I am not exaggerating. I’m barely even paraphrasing). What other people might think! I don’t think the patient is completely at fault here, because as Col. Walter Kurtz rightly put it, “It’s judgment that defeats us.” We are all inherently afraid of being judged, and that fear surfaces in these depressed patients at the sound of being on a drug for the mind, emotionally helpless as they already are. But what sickens me to my gut is when I see or hear someone judging, either vocally or with subtle facial expressions through which they so wonderfully communicate condescension, a person who is on antidepressants. No one judges patients with diabetes, heart diseases, renal failure, or any other physiological issues, but when it comes to a psychological issue, an emphatic “OH!” ensues. Right, here is the truth: clinical depression is neither a choice nor a reflection of the state of lives of people suffering from it. It’s as physiological a condition as osteoarthritis or congestive heart failure. Chronically depressed patients’ brains are physically incapable of producing the appropriate amounts of chemicals required to be happy. The only way to treat it is to fight it with an antidepressant drug, the way you would treat a backache with ibuprofen – i.e., with medicine! You can't (read slowly: CAN'T) cure it by thinking optimistically, thinking happy thoughts, taking a freakin break, or any other pop culture bullshit worthless advices people give. Go watch this enlightening Stanford video, educate your ignorant, harebrained ass, and refrain from making any smartass judgment calls the next time you hear someone is on an antidepressant: you could potentially save them their lives, just by being a decent human being. Too much to ask?
As Maria Bustillos, studying the reason for DFW's suicide, wrote the most sensible words I've ever heard from a lay person:
I have known intimately and looked after depressed people, and have no illusions about my ability to understand the real nature of that illness. The sort of blues I occasionally suffer through compares to real depression like a broken fingernail compares to being shot in the head and then set on fire and drowned. But it seems to me that the victims of that terrible disorder are often trying all their lives in vain to figure out why this must be so. Why them. And maybe there really is just no reason, or the reason is completely random, a cluster of neurons misfiring one day by accident, a bad thing that happens and could not be helped.
On a similar note, as much as I admire and appreciate Sir Ken Robinson’s intricate critique of the current state of our pathetic school/education systems worldwide, a glimpse of the judgmental attitude towards psychogenic drugs can be seen in these two (1, 2) million-plus-views Youtube videos of his. In the second video although he correctly admits that he is not qualified to comment on ADHD, he somehow believes he is qualified to comment on ADHD drugs. The very least bit of qualification required to comment on this class of drugs is to try one. But without knowing what it feels like to be on one, without conducting proper research into the drug, and without knowing what the drug does inside the brain, Sir Ken confidently posits that psychostimulant ADHD drugs numb your senses and enable you to focus on the “boring” subject by disabling you from attaining the heightened state of enjoyment you feel while watching a work of art. But the reality of it is hilariously contrary – ADHD medications heighten, NOT numb, your senses and therefore enable you to focus on whatever it is you want to focus on, including art. As someone who has tried modafinil, I can vouch for it, and so can academic sources and millions of others on it. Just try watching a film while on modafinil, and you’ll bet your life savings you are enjoying it better than Sir Ken. So making daft statements like these shows not just how uneducated (no pun intended) and biased he is against the science of mind and drugs, but also displays the stupidity of the audience that nods its heads and shares his judgment of ADHD drugs and of those who prescribe or support it. Another sad example comes from Doug Stanhope, one of my favorite and extremely bright comedians. As I said, I love both Robinson and Stanhope in all other respects but fall short of sympathizing with their disdain and judgment towards psych drugs. And all this is just a glimpse; the bigger picture is much uglier.
[I’m sorry about the tone of these two paragraphs above. I vent bitterly because I too was on an anxiolytic for a brief period last year, and save a few friends, pretty much everyone else gave me a judgmental look for it and it wasn’t too long before I realized this was a universal phenomenon that’s causing millions of people around the world to commit suicide simply because they’d rather deal with the consequence of not being treated for their psychological condition than be judged for accepting treatment.]
5. Antihypertensives
Approximately 1 billion people in the world currently suffer from hypertension (high blood pressure), and it is estimated that one out of every four people born will develop severe, chronic hypertension into their adulthood, and another one of those four will develop moderate hypertension (hypertension classification here). Hypertension has been academically called a “silent killer” because the symptoms of hypertension are so mild and unfelt over a long time that you become adjusted to its abnormality as normalcy and it slowly begins to eat away your longevity. One day, thud! Hypertension in rare cases can occur even at young age but normally occurs well into your adulthood, so antihypertensives are drugs that extend your days, and not (just) help you survive till you give birth. Many of us owe our parents’ and grandparents’ long life to this class of drugs.
Of course, utterly needless to say, every class of drugs is important, not just the ones I have chosen to mention here. From nutritionals to antivirals, NSAIDs to antipyretics, analgesics (very commonly used) to ACE inhibitors, insulin to even birth control pills and emergency contraceptive pills – sometimes not just to restore normalcy but to elevate normalcy up to higher standards of healthy living. Some are personally more important to us than any of these drugs mentioned above. But we all need them. Even those who prefer Ayurveda, Homeopathic and other alternative medicines and show a general sense of disdain towards Western medicine owe their existence to them, deny as they might. Pharmacology and medical science is what makes living today better than living in the past – more so than any other perks of human development.
____________
** (It's also worth noting that the death before reproduction of a single member of a species containing an undesirable gene isn't necessarily going to eliminate that gene from the gene pool. The individual's siblings, their chances of having inherited the same undesirable gene from the common parent, and other members of the species possessing the same gene - all influence how long a gene survives in the system, which is why undesirable genes tend to survive for several generations.)
____________
I have some thoughts on how wealth affects genes and the human gene pool from an evolutionary perspective, but they are still raw, disorganized and incomplete, so hopefully by next year I can write a blog post about it.
