Potions and Pills: Back to the Pharmaceuticals of Ancient Greece and Rome
by Nicole Vittoz

... considering the things that induce sleep: they all, whether potable or edible, for instance poppy, mandragora, wine, darnel, produce a heaviness in the head; and persons borne down and nodding all seem affected in this way, i.e. they are unable to lift up the head or the eye-lids.

-Aristotle: On Sleep

In the days of modern medicine with all its technical jargon, it may be difficult to take very seriously the medical writings of the scholars and physicians of the ancient world. By turns poetic and indelicately matter-of-fact, these documents nonetheless demonstrate an astoundingly rich world of medical and, particularly, pharmaceutical knowledge.

Modern pharmaceuticals, the mainstay of our medical system, have certainly come a long way from the potions and poultices of traditional cultures. In fact, medicines have much to do with our extended life expectancy. On the other hand, watching an advertisement for a new drug, with a list of side effects each more threatening than the last, can induce a suspicion that the cure must be worse than the disease! On top of that, designer drugs often come at a very high economic cost. It may just be that to improve our medications and to make them cheaper, we need to look back to the ancients and the records of a vast pharmacopoeia they developed over centuries of inventiveness, trial and error.

One of the richest sources of medical, and in particular, natural pharmaceutical knowledge comes from the writings of ancient Greeks and Romans. These works detail ingredients and recipes for antibiotics, medicines with direct physiological action, and others that alleviate suffering. Hippocrates, writer of the doctor's oath, and his Roman counterpart Galen wrote extensively about treatments and medicines. Unfortunately, all too often, the identity of plants mentioned have been lost, rendering their works largely untranslatable to date. At the end of the classical era Aristotle and his student Theophrastus described sleep aids such as poppy (opium) and mandragora, as well as mind-altering and even poisonous substances, such as belladonna and mandrake. The Roman Pliny gave detailed instructions for harvesting poppy juice for opium, still the source of the most effective pain relief known to modern medicine. He also wrote of castoreum, or beaver juice, which oddly enough consisted of aspirin created when the beaver chewed on willow bark. Lucretius, a Roman, wrote about foul-tasting wormwood, which became infamous in the 19th century as the active ingredient in the banned alcohol absynthe.

This is all interesting, for sure, but what makes it relevant today? One reason: the big pharmaceutical companies that bring us our modern miracle-drugs are in trouble. They are engaged in frenetic downsizing, merging and splitting, and restructuring around an inevitable reality. Lucrative patents are expiring, and public demands for cheaper drug prices are becoming undeniable. What does this mean for the consumer? Pfizer, Roche and others will stop the expensive process of designing drugs from scratch (although they will happily purchase such designer molecules from the more creative settings of small biotech firms and universities). Instead, they will make slightly different copies of molecules that are already proven and safe, and they will market drugs developed for one purpose as treatments of another problem altogether. (Viagra was originally developed as a blood pressure reducer... those must have been interesting clinical trials!)

At the same time, the business of herbal extracts and other natural products has become an enormous industry. “Natural” medicines and cosmetic products are largely unregulated and therefore are much less costly to produce. This represents a sort of back door for some types of pharmaceuticals to reach the public, and we can expect to see even more products in the herbal remedies aisle as big pharma moves to exploit this market.

Cost effectiveness and bypassing aspects of the drug approval process are not the only reasons for pursuing natural pharmaceuticals, however. In point of fact, the majority of modern drugs have their basis in natural products. The difference is that most modern synthetic drugs are extremely purified single molecules targeted toward a specific physiological pathway. Traditional naturally-derived remedies, such as plant extracts, are “impure” in comparison, and typically contain a number of different molecules. Ironically, as pointed out by Schmidt and colleagues at Rutgers University in the journal Nature, some of these impurities may actually enhance the effectiveness or the safety of the main medicinal ingredient. These additional molecules may support and supplement one another. Pharmaceutical companies are beginning to realize this and as a result many new drug treatments will be multi-target, using combinations of molecules that reduce resistance to the main compound or alleviate unwanted side effects. Going back to the original natural sources of the modern molecules will be important for identifying other players in an effective molecular “team”.

Another important difference between typical modern and ancient treatments is the method of administration. In the ancient world, no one had heard of an injection or a pill. The most common method of preparing a medication was to mix the active ingredients in wine and drink them, often using honey or other sweeteners to mask bitter flavors. Occasionally, medicines were administered via poultices to be absorbed through the skin, while in other cases they were inserted into the nose (snuff), inhaled as smoke and vapors of burning herbs, or taken as suppositories. As we return to the wisdom of long tradition, we also see that a pill is not always best. You may have noticed that more medicines are being offered as patches: essentially a modern version of a poultice. In instances where marijuana is considered a legitimate medicine the most effective way to use it is to smoke it, our modern means of inhalation.

Before you worry that we know very little about how these “natural” drugs really work, scientists are already hot on the trail, researching the active compounds in some of the most popular herbal remedies. For example, by identifying changes in brain chemistry induced by extracts of Gingko Biloba and St. John's Wort, researchers have confirmed a scientific basis for their traditionally renowned efficacy in enhancing memory and treating depression, respectively. In fact, some of the chemical effects of St. John's Wort are quite different from those induced by Prozac and other modern antidepressants, and may thus represent a good alternative therapy. The identification of the active compounds in extracts inspired by traditional medicine and the careful study of their effects can lead to the establishment of these compounds as treatments for a variety of ailments. Through careful breeding or genetic engineering, we can even produce versions of these plants that contain even more of the important chemicals. As an example, through selective breeding, the active ingredient in marijuana plants has increased by a factor of more than 10 over the past 30 years.

Can it be that our grandmothers' concoctions, prepared with the axiom “the fouler-tasting, the better”, will emerge as the basis of the next medical renaissance? Could the marriage of modern scientific technology and training with the traditions of ancient cultures produce a medicine cabinet with contents more effective, well-tolerated and with greater variety than ever before? A return to traditional drugs may be an important new direction in modern pharmaceuticals, and in that process we can be sure that the remedies so carefully catalogued by the intellects of classical Greece and Rome will play a central role.

Nicole Vittoz completed her Ph.D. at the University of Wisconsin, where she studied the effects of a recently discovered neurochemical. Her current work as a postdoctoral fellow at the University of British Columbia seeks to unravel the mysteries of one of the most complex parts of the brain.