Why Louis Pasteur would have liked Nexium, reflections on chirality
Reflections on Chirality
There are several aspects that I would like to bring out in the title. I would like to include a series of historical vignettes about why Louis Pasteur and some of his counterparts in the mid 1800's opened a way to how we view medical treatments today.
Pasteur in his early work on crystallography set the tone for many of his subsequent observations in the life sciences which went on to revolutionize medicine as we know it today. The concept of mirror images--chirality were first described by Louis Pasteur in the 1850's and gave vivid contrast between the symmetry of minerals and the subsequent importance of asymmetry in the life sciences. This approach should give us an additional appreciation in the role that historical personages played in the foundations of subsequent life sciences and medicine.
It will give me an opportunity, also, to bring you up-to-date on the latest in basic biochemistry involved with proton pump inhibitors as well as the impact they have had on medical management of acid peptic diseases in the last 20 years. The forces that have led to a world-wide push to change the most popular drug in the world, Prilosec, to an alternate drug, Nexium, will also be discussed. The role of the FDA in setting up this transformation is of particular interest. The basic economics of medicine, as we know it, will be impacted dramatically by many of the advances that are to be presented with Nexium as the sentinel example of such changes.
The first slide is a summary from the French School in about 1830 describing a patient who was found to have epigastric pain. As one might note, the patient went on to have hematemesis followed by gross anemia. The up-to-date treatments of the time included mustard plasters to the feet, and when he was showing some improvement but small amounts of hematemesis still present 20 leeches were applied to the epigastrium. Additional mustard plasters as well as rice extract and a syrup of quinces led the physicians at the time to feel that he was better. Additional leeches to the anus were applied as well as mustard plaster, but to the surprise of the treating physicians, the patient had sudden hematemesis and died. His autopsy did reveal a lesser curvature gastric ulcer. Treatments have definitely changed in the past 170 years. Many of the initial treatments for peptic ulcer disease today can be looked at with almost humor if not sadness given the level of understanding available to physicians at the time.
Two months ago a patient from Brewton brought me a copy of her instructions that were given to her in Birmingham in the early 1940's. These handwritten instructions were for the Sippy diet which included hourly feedings of milk, eggs, and purees. Modifications of the diet included subsequent inhospital stays with a nasogastric tube and dripping of milk. Broad-spectrum anticholinergics of the atropine family had such serious side effects that there was little doubt that the evolution of stomach and duodenal surgery were really in their heydays of the 1940's through 1960's. Certainly, in the late 60's to early 1970's there was not as much push-pull between the surgeons and the medicine physicians--medicine had very little to offer the patient who was really quite sick.