Ugly Ducklings

Sep 17, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Crazy Florida pastors threatening to burn the Islamic Holy book, the Quran, make excellent headlines. Pharmacy stuff can be interesting, too. No, really, it can be. For example, new drug discoveries always make good headlines. A new drug is exciting and gives us hope. We start thinking scientists might be making some progress against the many afflictions that stalk us. In early September, the news said that the old diabetes drug metformin may have a new use. That got me excited. It also made me think of fairy tales.

In the tale of the ugly duckling, there was a large misshapen duckling in a brood of normal ducklings. Because he was so hideous his siblings chased him out of the family. After some misadventures, he grew up to find he had become a beautiful swan. One ugly duckling drug was sildenafil. Sildenafil is better known by its trade name, Viagra. In 1986, scientists at the drug company Pfizer were trying to develop a new blood pressure pill. They found a compound that inhibited the phosphodiesterase family of enzymes. That enzyme block caused blood vessels to open up and the blood to clot less, but it didnt lower blood pressure. The scientists thought it might work for angina. Angina is pain in the chest caused by not enough blood to the heart muscle. When the scientists tested the drug versus angina, it didnt do so well, but some patients reported the surprising side effect of penile erections. Thus began every Viagra joke youve ever heard.

In Sleeping Beauty, a teenage girl doesnt listen to her parents. They told her to never, ever touch a spinning wheel, but of course she did and poked her finger on a spindle. Then she fell asleep for a hundred years. She didnt wake up until her prince charming found her and gave her a smooch. The drug fluoxetine had to wait a long time until it saw the light of day as well. Better known as Prozac, its development began in 1971 at the Eli Lilly company. At that time scientists were looking a rat brains and discovered that if they stopped nerve cells in the rat brains from sucking up serotonin from the gap between cells, they could increase the amount of serotonin in the rat brains. One of the theories of depression is there is not enough serotonin in the brain. So the scientists found a chemical in 1972 that stopped the re-uptake of serotonin. That chemical was Prozac and it was one of the early SSRIs or selective serotonin re-uptake inhibitors. Early on many other scientists said this new form of antidepressant would never work. Antidepressant sales in the US were $200 million in the first 8 months of 1975 and the market was thought to be saturated. It took until 1987 for Prozac to be approved in the US. By 1992 Prozac sales had reached $1 billion. By 1995 they had reach $2 billion. By 1999 Prozac was named one of the Products of the Century by Fortune magazine. So it took nearly 2 decades from when the original research in rats was announced until Prozac woke up and charmed the world.

I think metformin may end up being both a bit of an ugly duckling and a bit of a sleeping beauty. Metformin is a drug we currently use to treat diabetes. It has been around for over 20 years. Some cancer researchers have been giving it to mice. These mice have been genetically altered to get lung cancer easily. When the mice were given metformin orally they developed 34% fewer tumors. When metformin was injected, they developed 73% fewer tumors. How does a diabetes drug treat cancer? Well, we really dont know, but one of the actions of metformin is to reduce how much insulin is produced by the body. The scientists think that insulin may influence how the tumors grow. As exciting as this new research is, it will probably be several years before we know if metformin is safe and effective to use in people with lung cancer. So even if metformin grows up into a beautiful swan of a effective cancer treatment, it will be many years of sleeping in labs and clinical trials before it can be woken up and used to charm us to health in the real world.

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