Introduction - Uppsala Monitoring Centre

Where there were several herbs with different active principles but had similar actions,
the one with the best benefit/risk ratio may have been called a medicine
whereas the one with worst benefit/risk ratio may have been called a poison.
Where there is a narrow therapeutic ratio individual variations in response may
mean that a large number experience adverse events and may consider themselves
poisoned.
The term was probably used very loosely by the early writers expressing their
lack of knowledge of the herb or expertise in using the herb correctly and at the
same time wishing to err on the safe side. The Anglo-Saxon word for poison was
‘bane’ hence ‘henbane’, but now means ‘cause of trouble’.
Demise of Drugs
The life expectancy of humans has increased steadily with acceleration from the
1950s whilst the life expectancy of drugs has been the reverse with a slow decrease
accelerating since the 1950s. The factors involved are probably:
The discovery of the active principle of herbs making the herb redundant, e.g.
opium → morphia, henbane → hyoscyamine.
The discovery of better drugs for the same purpose, e.g. arsenic for syphilis →
penicillin.
The manufacture of the drug is no longer profitable.
A worsening of the cost/benefit ratio due to the discovery of a new serious ADR,
e.g. thalidomide.
A change in medical philosophy, e.g. realisation that purging was not beneficial to
the patient - hellebore.
The corollary to this is that there are factors, which prolong the life of a drug, such
as:
a. The development of a salt of the original drug, e.g. Hg → Hg 2 Cl 2 →
Merthiolate/mersalyl
b. The discovery of a niche market, e.g. thalidomide for leprosy
c. The discovery of a new application, e.g. Aspirin for prevention of diseases.
In the Massachusetts General hospital there was steep decline in use of
several drugs from 1820 until 1880.
Calomel 1820 - 58 %; 1880 - 5%
Tartar emetic 1820 – 21%; 1880 – 0%
Ipecacuanha 1820 – 12%; 1880 – 0%
And also in procedures: venesection 1820 – 46%; 1880 – 10%; cupping 1820 –
9%; 1880 – 0%; leeching 1820 – 12%; 1880 – 0% [approximate figures from a
graph] (Warner, 1990).