What is a medical drug? Ask anyone on the street and they’ll likely tell you it’s something you take when you’re down.
This understanding is wrong, as we will see. But after careful investigation, my colleagues and I did not find that other possible definitions were not better.
Despite their centrality to medicine, we have no idea what medical drugs are. We can’t even tell the difference between drugs and food, let alone between drugs and so-called “natural” alternatives.
In a recent article in the Journal of Medicine and Philosophy, my colleagues (Sarah Linton, pharmacist, and Maureen O’Malley, philosopher of biology) attempted to define a viable definition of medical drugs.
A viable definition must be broad enough to include anything that is classified as a drug. To understand what this “everything” means, we used the drug bank compiled by the Canadian Institutes of Health Research, which lists more than 16,000 substances.
The definition must also be narrow enough to exclude substances that are not normally considered drugs. Take food for example. Eating a sandwich is usually never thought of as taking drugs.
In short, a viable drug definition must occupy the Golden Zone between these two requirements. big enough to include all drugs, small enough to exclude everything else.
Based on a preliminary study of pharmacology textbooks, we found three broad ways of defining drugs:
Unfortunately, none of these options fall into the Goldilocks zone.
Are drugs special chemicals?
If all drugs were a certain type of chemical, defining drugs would be easy. But this idea is hopeless. nothing chemically, all drugs have something in common.
It’s also tempting to think that drugs are “artificial” chemicals made in a lab, while “natural” supplements come from nature, and that’s the difference.
But many drugs are “natural” in this sense. Aspirin, for example, is obtained from willow bark.
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This has a direct effect on so-called “natural” supplements such as fish oil.
If “drugs” are chemically indistinguishable from “natural” supplements, supplements should not be considered a “safe” alternative. Supplements are no less and no more safe than most medications.
Do drugs perform a specific function?
Perhaps drugs can be defined by what they do. This idea seems promising at first because many drugs work by binding to receptor molecules in the body.
Think of a lock and key. the receptor molecule is the lock and the drug is the key.
The discovery of receptor molecules is significant. For some, it is the “big idea” of pharmaceutical science.
But this definition of medical drugs is also hopeless. Many drugs do not bind to receptors. Antacids, for example, work simply by changing the level of acidity (pH) in the human body.
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Many placebos also bind to receptors. Placebos are often contrasted with drugs, but drugs as “things that bind to receptor molecules” define many placebos. So this definition won’t work either.
Is there a way to define placebos that clearly differentiates them from drugs? This is not obvious because the definition of placebo is also quite difficult.
For example, placebos can be thought of as substances that have no therapeutic effect. But placebos can have a therapeutic effect (the so-called placebo effect), so this definition won’t work. A number of other definitions face similar problems.
Our research paves the way to an explanation of why it is so difficult to define a placebo. To properly define placebos, we must distinguish them from drugs, which we cannot do without defining what drugs are.
Drugs make me better
This brings us back to health. According to this view, a medicinal drug is simply any chemical substance used in medical treatment.
This does it better. it includes the entire range of substances used as drugs in a medical context.
But now there is absolutely no hope of skipping food and nutrients.
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Consider, for example, total parenteral nutrition. This is a chemical infusion given to people who have trouble absorbing nutrients normally.
Total parenteral nutrition is used in medical treatment. But what it does for your body isn’t really that different from a good sandwich.
Any account based on drug treatment inevitably omits the food contrast.
In our daily lives, we make decisions based on an implicit understanding of drugs.
For example, we take paracetamol because it is a medicine. Many of us may also take fish oil just because we think it’s not a drug.
Without considering what the drugs are, we risk making serious mistakes.
We can take substances that we think are “inert” (placebos) because they are “natural” (like fish oil), when in fact they are active drugs.
Likewise, all legal regulations for medical drugs assume that we already know what the drug is.
But we don’t do that. our understanding is clearly evolving. This means that the regulation must also be constantly changing. Therefore, significant resources need to be devoted to redesigning the legislation as we continue to review what medical drugs are, as demonstrated by the recent reclassification of MDMA and psilocybin as drugs in Australia.
Then there’s the food. Food is not administered or regulated like medicine in a hospital, except for total parenteral nutrition and similar substances.
But if doctors use food like medicine to promote a patient’s well-being, then it should probably be held to the same standards.
This may require a radical rethinking of the way food is provided in the hospital. Perhaps food should be managed and regulated with the same care as drugs.
Hospital meals may never be the same. But that can be a good thing.
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