Horizon (1964) s48e10 Episode Script
Pill Poppers
Over the course of your lifetime, you're likely to be prescribed more than 14,000 pills.
Tiny little spheres of crushed powder with almost magical effects, pills that will possibly save and extend your life by decades.
Any medicine actually is a miracle.
If you really think about what a medicine does, that you can design a small chemical to interfere with a biological process to alter disease I mean, it is just astonishing that you ever get there.
These miraculous pills often owe as much to serendipity as science.
We started with a drug that we hoped would be effective in angina and we ended up with a medicine that was highly effective in erectile dysfunction.
This accidental nature of drug discovery means little is known about what they can do until we all take them.
In many ways you learn as much about your medicine after it's launched as you knew before.
The results of this process can be unsettling.
When you take a tablet, you're entering into a bargain.
Our side of the deal is that we honestly believe the tablet will do you more good than harm, but you have to accept the possibility that it may, in the long term, do you more harm than good.
We just don't know that yet.
Our relationship with pills starts from the very beginning of our lives, from the medicines handed to us by our parents.
I used to get so upset having to take these pain killers because I didn't want to, so my mum, I was probably about five, and my mum used to snap them in half and tip the actual medication into orange squash for me.
My mum gives me my tablets every day.
As we grow up, we begin to pop pills for everything.
There are the antibiotics we take to fight off disease, more than one course every two years of our lives.
The 28,000 pain killers we each take to make us feel better.
Pills to stop us having babies.
I actually got pregnant on the pill.
So Medicines to carry us through middle age.
Statins.
Simvastatin.
Simvastatin.
Even tablets to extend our youth and improve our performance in bed.
Yes, yes, I have used it.
The first month it came out.
By the time you're in your 70s, you'll probably be taking at least five tablets a day.
The pills we take define who we are.
Pills are just part of my everyday life.
And what we are.
I take a lot of pills.
Matter of fact, I take 15 a day to keep alive.
But they're not always beneficial.
We read through the back and I had every symptom on that packet.
How much do we really know about the pills we take? And can we trust them to do what they're supposed to? This is a temple to modern science - the pharmaceutical labs at GSK.
But modern drug discovery relies more on an automated lottery than careful design.
This store of chemical compounds is the company's crown jewels.
This is where their new drugs come from.
In here is a library of over two million nameless chemical compounds.
The scientists know very little about them.
They could be highly toxic, or they could be harbouring a life-saving drug.
It really is trying to find a needle in a haystack.
It is about getting the samples out, processing them, screening them and hoping we find that that chemical compound that is active against those disease areas.
This is where the lottery begins.
A known disease molecule, called the target, is introduced to each of the two million compounds, one by one, to see if anything happens.
With the two million or so compounds, we might get a few compounds that are active against that target.
We then have to take that one or two hits and the chemists will make hundreds, maybe thousands, of samples related to that original structure to try and improve the activity and most importantly try to negate any safety or undesirable effects.
We have to screen those over and over again to make sure that we're going in the right direction.
After hundreds of millions of tests, just a handful will make it through to trials on people.
In all, it takes about 1 billion and 15 years' work to find the winning compound that can become a licensed drug.
The journey to a medicine is an epic journey.
That whole process from idea through to a drug approved is one littered with failure.
Despite the minute success rate, the potential rewards are enormous.
We hope there would be chemicals in here that would be the future cures for all sorts of disease areas.
It would be nice to think that here we do have the cures for cancer, AIDS, malaria, any of the World Health Organisation top priorities.
If drugs are not designed but discovered, then it should come as no surprise that we only find out what they really do to us when we take them.
Give me your hand.
Give me your hand.
Liam! This is Liam.
Aged five, he was disruptive, hyperactive and unable to focus.
Liam, there's cars coming.
Straight here now! And this is Ed.
I've just finished my law exams for this year.
I've got a triathlon coming up in two days' time and I've got a couple of jobs on the go at the minute so things can be quite hectic.
It does sometimes feel like there aren't quite enough hours in the day.
Don't, Liam! For very different reasons, both Ed and Liam have found benefits from the same drug.
Aged five, Liam was diagnosed with attention deficit hyperactivity disorder, ADHD.
Come on, your hot chocolate's ready.
Now, five years later, Liam's life has been transformed.
Here you go.
Thank you.
One, two, three, four, five.
Excuse me.
Whose go is it next? Mine? No it was me, you His newfound ability to concentrate is largely thanks to a drug called methylphenidate, best known to most of us by a brand name - Ritalin.
It takes about 30-40 minutes for it to work, and it's not like Liam suddenly goes docile.
It just basically does have a calming effect on him.
He doesn't seem to be as hyperactive on the medication and he is able to sit quietly, be able to focus on things like his homework or just, just basically have a more normal life, really.
And, as for thousands of other children, Ritalin has had a remarkable effect on Liam.
I feel calm.
I don't feel like excited.
I feel energy because I can just run around all day if I wanted to but I'm just calm now.
And I'm excited as well.
Now without the medication, you could ground Liam and he would go back the next day and do the same thing that he'd been grounded for.
With medication it just enables him to consider the consequences, a little bit more clearly, of his actions.
It was only by accident that researchers discovered drugs like Ritalin could help children with behavioural problems concentrate better.
These drugs were originally designed 50 years ago for the treatment of adults with depression.
It's only now we are beginning to understand how they work.
ADHD is believed to be caused by an imbalance of key chemical messengers in the areas of the brain that control attention and working memory.
Ritalin appears to make these messengers more effective, helping to restore attention.
Like all drugs, Ritalin comes with a cost.
It can cause a loss of appetite and insomnia.
But now another benefit has been revealed from which we could all profit.
Initially when I took the Ritalin, I didn't feel any difference.
Only really afterwards did I actually notice that I felt slightly more focused than I usually do.
I found it really difficult to kind of get into that mental state where I kind of felt I could just sit and do nothing.
I found myself looking for things to occupy my attention.
Ritalin can work as a cognitive enhancer.
If a person without ADHD takes it, it can make them cleverer.
It's a discovery not lost on the country's academic elite.
Here at Cambridge University, students are abusing Ritalin or its close relative, modafinil, to help them get ahead.
A few of my friends do what they call modafi-vising.
It can keep them up for 24 hours and they can keep on going.
I think they feel pretty shocking after it, but if you need to do a lot of work in a short amount of time, then that's one way I've heard it can be done.
People who do take Ritalin, I think they see the benefits of it and it does help them with their revision.
My friends that do, tend to do pretty well but I, I like to think that's because they're quite clever.
Ed wasn't taking Ritalin for illicit gain.
He took it at the behest of this woman.
Barbara Sahakian is Professor of Clinical Neuropsychology at Cambridge University.
She's researching what drugs for those with ADHD can do to the brains of the healthy.
Well, we knew that the drug worked as a cognitive enhancer for conditions like attention deficit hyperactivity disorder, but would they also work in, in healthy people who didn't have any problems? Could we actually boost cognition in somebody who was you know functioning well? Ed was one of her research volunteers.
They were each given Ritalin and put through a variety of intelligence tests.
Not only were we able to show an improvement in their ability to do say a task like spatial working memory, but they also showed an increased efficacy in the neural networks in the brain that were required to perform that task.
Professor Sahakian found the drug had also boosted levels of chemical messengers in healthy brains, increasing their concentration levels too.
We were a bit surprised that in healthy people you could boost cognition.
It reveals ADHD is not a black and white disorder.
It's a spectrum, a spectrum we are all on.
Some people are very impulsive, other people are not impulsive at all.
I think we all know friends of ours who might do something that we wouldn't do and then it's a question of if we go further up that spectrum, that we may start to find somebody who is actually not functioning very well because their impulsive behaviour or their lack of attention is very bad and therefore they do actually need a treatment.
This potential to make us all cleverer opens an ethical minefield.
I think it is cheating because it's not your natural self.
If you want to do well, I feel that should be a personal achievement as opposed to enhanced by artificial mechanisms.
If a lot of people took it, then people would HAVE to take it to be able to compete with their peers.
To be perfectly honest, doing what it does, if it was legal, and it was safe, everyone would be doing it.
Already it's being put to use amongst professionals.
Professors are using it to help them work, and surgeons are looking at it as a way of staying alert during long and complex surgery.
But for Professor Sahakian the question remains - will it actually make our lives better? Suppose we took cognitive enhancing drugs and we got all our work done in a short period of time, we could go home, spend time with our family and improve our work/life balance.
That would be great.
But it's more likely with the type of society that we seem to be moving towards that it will be this 24/7 society so we'll take these drugs so we can work longer, so we can travel more and do more work so it will disrupt our work/life balance even more.
I'm always looking for ways that I can squeeze more in.
At one point I did think I'm going to have to give up eating, sleeping or one of my jobs.
It did cross my mind actually that if I could get my hands on something like that again, it would be, you know maybe to my advantage.
I'm not sure about a pill that would make you more intelligent.
We're happy being a bit on the thick side.
Yeah, being a bit thick's OK.
We'd like to think our drugs are designed for exact purposes, but they're not as targeted as we think.
We only discover where in our bodies they work when we take them.
It turns out Ventolin inhalers, a treatment for asthma, can also prevent premature labour, and arsenic, a notorious poison, is making a comeback as a treatment for leukaemia.
Even the fastest-selling drug of all time is not used for what it was designed.
It started life as UK 92480, one of millions of compounds in the stores at the drug company Pfizer.
They were looking for a new drug for angina, something that would relax blood vessels around the heart.
After screening hundreds of thousands of compounds, they ended up with UK 92480.
But its trials in humans were a let-down.
It was about to be consigned back to the stores when the trial volunteers started coming back and reporting an unusual side-effect - lots of erections.
Add the drug the relaxation's get larger but its trace is upside down.
By making a crude mock-up of the human sexual apparatus, senior scientist Chris Wayman found an ingenious way to test this anecdotal evidence.
These are actually penile blood vessels that we have in a tissue bath.
Think of this as the brain.
This is the brain and the spinal cord.
When you're becoming aroused, your brain switches on.
We can mimic this by switching on the equivalent of the central nervous system in the brain.
It sends electricity down to the tissue bath and across the tissues, and when we pass an electric current across these small pieces of penile tissue, they relax and ultimately that's what happens during penile erection.
Relaxed penile blood vessels mean more blood flow to the penis, and so an erection.
What Chris did was take penile blood vessels from impotent men, vessels that didn't respond when he flicked the brain switch, and then added UK 92480 to the tissue bath.
What was most amazing about this study was that we saw a restoration of erectile response.
It's very rare in any tissue preparation to convert dysfunctional to normal function, and so now we were really onto something that could only be described as special.
At the time there was no oral treatment for erectile dysfunction.
No-one even really knew what caused the problem, but suddenly Pfizer had a potential treatment on their hands.
When this data was shared with the experts in the field, the urologists, they were astounded.
I remember a meeting in America at the Urological Association where the room was packed when this data was released because no-one had seen anything like this before.
UK 92480 was renamed Viagra, and within weeks of going on sale, tens of thousands of prescriptions were being written every day.
You would never have been able to predict that this was going to have beneficial effects on millions and millions of men throughout the world, a little bit of science having effect on self-esteem, anxiety, depression levels and ultimately creating enhanced relationships.
Viagra is now one of the most prescribed drugs in the world.
Six tablets are dispensed somewhere every second.
But some have begun to ask whether so many men need it.
When it first came out, it was definitely seen as a medical drug for a chronic condition, a medical condition, but obviously they suddenly became aware of a huge market capacity.
They began to market it to men who occasionally didn't have an erection as opposed to consistently didn't have an erection, and the message shifted from being, "This is for you if you're ill with another health problem", to, basically, "You can always have great sex.
" Viagra wasn't the only one to do this.
I mean, the other sex drugs like Levitra and Cialis that came on slightly later all use a similar marketing strategy.
Pfizer claims more than half of all men over 40 have difficulties getting or maintaining an erection.
But this figure is not universally accepted.
We estimate it's around 9% of men who have it as a chronic condition, and that's usually linked to older men and men who have got other health problems.
In terms of men occasionally having problems with erections, most men would actually probably do that and that's quite normal.
The implication is that if you're falling short of 100% perfection, that, you know, the pill may be able to help and, in essence, this means that you're ill.
But of course being 100% perfect is not normal.
This is not the normal state.
Being normal means being slightly different from one day to the next.
Pfizer stands by its claim.
But this throws open the question, what is a medical condition? The latest target is women with a low sex drive.
It's even got a medical term - female sexual dysfunction.
Already the race is on between drug companies to find a cure.
But is not wanting sex necessarily a medical disorder? The idea that you categorise a problem of female sexual dysfunction or FSD, I think is the best example we've ever had of creating a market for a disease and kind of creating a disease out there where none existed before.
Because if you think about it, a lot of women would say they don't want sex very much because they're tired or they've got low self-esteem.
There's a joke we make which is if you can create a pill that would make your partner do the housework, it would probably be more beneficial than giving women a drug that would actually boost their sex drive.
Pills and sex can be a lucrative combination.
But sometimes drug companies are not the first people to see that.
In the UK, one third of all women of reproductive age take the contraceptive pill.
Worldwide, a hundred million rely on it, but it almost never reached the market.
In the 1950s, research into contraception was illegal in many parts of the world and where it was legal, pharmaceutical firms feared a moral backlash.
Despite this, independent researchers did discover how to synthetically create female hormones.
They realised giving these to women as a pill would change their fundamental biology and stop them ovulating, preventing them from getting pregnant.
Pharmaceutical companies were reluctant to back the project, so when one did get behind it, the pill was brought to the market as a drug for heavy periods, but women soon cottoned on to its real potential.
It's just allowed people to manage their fertility and their families, and has liberated people in that sense.
In the past, a lot of people were stuck with families that were getting bigger and bigger because they just couldn't stop babies from coming, and really within the last sort of 40, 50, 60 years we've been able to manage that and have the families of the size that we want, which has led to healthier children and happier families.
The result was a social revolution.
On the male side however, contraception hasn't changed since rubber condoms and vasectomies were invented in the 19th century.
Men still don't have a pill of their own.
What's stopping it is a question of numbers.
To produce effective contraception for a man by suppressing the sperm production, you need to suppress something like two hundred million sperm from being produced from the testes every day, and that is quite a big challenge compared to suppressing the production of one egg every month in a woman.
Now, after years of research, Professor Fred Wu and his team have found a way to prevent so many sperm being produced, giving men powerful sex hormones, tinkering at the heart of what makes a man a man.
It switches off the hormones from the pituitary gland, so basically the testes stop working.
It's put to sleep.
Unsurprisingly, this process has a major side effect - the very emasculation of the patient.
In order to restore their manhood, some more hormone altering is needed.
At the same time we're giving back the testosterone, so that the male features and the male characteristics are fully preserved.
The result, in theory, is a fully functioning man, just without sperm.
It may sound extreme, but it's no more radical than what millions of women endure.
But Professor Wu is finding it hard to get the backing of a pharmaceutical company.
It seems times have changed.
We are now more wary of meddling with our bodies than 50 years ago.
If the female contraceptive pill was developed from scratch now, it would probably come across exactly the same difficulties as we are at the moment.
Professor Wu remains undaunted.
There is definitely a potential market for it, and I think once a product like this is marketed, it may well lead to changes in attitudes, social changes, similar to what happened with the female pill and then I think it is likely to lead to a much larger market than the companies think there is at the moment.
There is one problem Professor Wu can't solve.
When it comes to pregnancy, the stakes will never be as high for men as they are for women, and with that comes a question of trust.
I just don't think they'd do it.
I think it's something that men tend to rely on women to do and take the responsibility of.
No offence, guys.
If you met somebody, a man, and he just said, "Oh, it's all right, I take the contraceptive pill," I'm not sure I'd be willing to believe that.
But then I dare say there's some women that you can't trust to take it.
I don't think it's just men.
Well, absolutely, yeah.
I'd probably be standing over him watching him take it so They can't even put socks on in the morning, you know, how are they going to take a pill at the same time every day? Pills don't just affect our bodies.
They can treat our minds, and sometimes finding a successful medicine for an illness can even change the way we view ourselves.
Depression is a case in point.
In the 1950s, depression was a strictly private affair.
Those that sought help got little in return.
The few drugs that were on offer were unlikely to lift your spirits.
You would have dry mouth, blurred vision, problems passing urine.
You'd feel knocked out and dopey.
It would be barely better than the situation you were actually in to start with.
It all changed when a new wave of drugs came along.
Scientists had realised that a brain chemical, serotonin, affects our mood.
If they could find a way to boost the amount of serotonin in the brain, it could improve our sense of wellbeing.
They tested hundreds of compounds and managed to create a new class of drugs that had a fraction of the side effects of the older anti-depressants.
This group was termed selective serotonin re-uptake inhibitors, SSRIs.
Soon they were known simply by the brand name of the first one on the market, Prozac.
Suddenly depression had become a treatable condition, and that made it more socially acceptable.
If you have an effective treatment for a condition, people who suffer from that condition will come out of the woodwork and you'll find more often that, build it and they will come.
By the 1990s, the number of people coming forward seeking treatment tripled.
Soon SSRIs were a solution to everything.
Back in those days, if you came into a GP's surgery looking a little bit glum cos someone stole your bike or your dog died, you'd be assessed as being depressed and be given anti-depressants.
Way overkill.
Everyone now admits that was true.
In time, the tide began to turn against SSRIs.
As more and more people took them, some disturbing serious side effects began to emerge.
The risks are that approximately one in five people will become much more anxious on these drugs, that one in 100 or so will go on to a suicidal act, that one in the area of something like 500 to 600 people may go onto complete suicide, who wouldn't have done so if they hadn't been on the pills.
One drug in particular came under scrutiny.
The makers of the controversial anti-depressant drug Seroxat have been criticised by the health care regulatory body for withholding information about the risk of suicidal behaviour associated with the drug.
In 2006, GSK, the makers of Seroxat, one of these SSRIs, admitted that Seroxat raised the risk of suicide eight times.
Sadly, side effects from drugs are nothing new.
Thalidomide was the great drugs disaster of the post-war era.
Given to expectant mothers with morning sickness in the late 1950s, it was not long before its devastating side effect became clear.
It was withdrawn in 1961 and brought with it new trials procedures that were supposed to prevent anything like it happening again.
But they haven't.
There are warnings that a drug used worldwide by millions of people with arthritis could increase the risk of heart attacks and strokes.
Doctors have been told to stop prescribing a drug commonly used in the battle against obesity.
The benefits no longer outweigh the considerable risks.
In the last five years, in the UK alone, eight drugs have been withdrawn from the market by the regulators.
The anti-obesity drug, Rimonabant, was banned because it could cause suicide.
Vioxx, used to treat rheumatoid arthritis and menstrual pain, was withdrawn after it caused 140,000 heart attacks in five years.
The discovery of undesired effects is, however, intrinsic to the experimental nature of medicine.
Clinical trials are done on thousands of people, but some side effects are only found when hundreds of thousands take them, when the drug comes to the market.
You might start picking up side effects that you couldn't have anticipated, that you didn't know, that are relatively rare but nonetheless can sometimes be important.
Drug development is an ongoing clinical trial in which we all play a part.
There's no such thing as a totally safe medicine.
There's no such thing as a medicine that we know absolutely everything about and therefore there is some uncertainty, and that persists.
Because this goes to the heart of what medicines are.
When you make a medicine, you're trying to disrupt a fundamental biological process.
That's a pretty profound change.
You can't do that without producing some unwanted effects.
So then the question is, what risk are you prepared to take for what benefit.
Side effects are not restricted to the dangers written on the back of the packets.
For hundreds of thousands of people, the thing that set out to be the solution has become the problem itself.
I'm thinking, "Oh, lovely", then I think, "I've got to have my tablets", I just want this uncomfortable feeling to start going, really.
That's all I want it to do.
These used to be my best friends.
They're not now.
I hate them.
Jo Palmer is addicted to pain killers.
It changes your personality totally.
You know ,I hated the person that was emerging from it and I still do.
Jo's addiction started 18 years ago when she was prescribed strong pain killers to deal with chronic pain.
But by the time she'd been cured, she found she couldn't function without the drugs.
Over the years, the addiction has taken over her life, causing pain itself, limiting what she can physically do.
Jo has struggled to overcome her addiction but she can't escape it.
The problem is that she can score her drugs on the high street.
There is quite a lot of chemists when you look round, and you go in and you do it on a rota system, so one chemist thinks that you're just getting them once per week.
But then you drag people into it and you don't mean to.
But you, you know, when I asked my husband to get them for me, he honestly said to me, "I can't, I can't go in there and get them for you.
"It would be like dealing to you.
You know, "this could be the one that kills you and I'd never forgive myself.
" Jo is still battling her addiction.
The drug she craves is the codeine in extra-strength pain killers.
Codeine is an opiate, the same family of drugs as class A street drug heroin.
As well as killing pain, codeine gives a feeling of calm, of wellbeing, that can be more attractive than the pain-killing itself.
It is incredibly easy to get addicted to pain killers and there's an epidemic, that's not too strong a word, of usually women out there, who are entirely dependent on codeine-based pain killers.
But just like any drug, you build up tolerance and it's this that lies behind the addiction.
The more you take, the less effect it tends to have.
So you start out taking a small dose.
You need a bigger dose and a bigger dose and you finally end up in a sort of vicious circle where you have to keep increasing the dose over and over, to get the same effect in terms of pain relief.
I was at 70 a day.
If I gave it to you, or anybody else, it could kill you.
Me, I'm not saying it can't kill me.
I am at risk of that, but my body has been more used to it than you.
It's not just pain killers.
Many medicines have the power to lure us in.
I had a situation where I kept waking during the night and I couldn't go back to sleep.
I tried everything I could, so basically I went to see the doctor and I explained to her what the problem was.
The tablets that she prescribed me was only a short-term thing, six to eight weeks, and I've been on them for about 20 years, something like that.
When I was on steroids, when I was a lot younger, I can always remember looking at them thinking, "Can I actually give them up? When I'm in pain, what am I going to do, what am I going to take?" Gradually, as the years went by, I began to realise that I was seriously addicted and I just needed more and more.
I couldn't get off them.
I can remember my mum tipping them down the sink, saying, "You can't have any more.
" And once I got it in my head that I could, I could do without them, I was fine.
I feel great now.
I feel absolutely great.
I'm drug free.
Jo reached rock bottom in 2006 and has been trying to turn her life around since then.
She's on the slow road to recovery, battling against withdrawal symptoms of nausea, pain and anxiety if she cuts down too quickly.
I've got it under control now, to about anything from ten to 20 a day, on average.
Who's a good boy?! 'It's to keep off the withdrawals.
' Drop it there! Good boy! I live day for day.
And I hope, one day, that so many will go down to so many, and then go down.
I don't ever give up trying.
But many people question whether codeine even needs to be in these over-the-counter drugs in the first place.
One of the things about the over-the-counter pain killers that contain codeine with aspirin or paracetamol or ibuprofen is the amounts of codeine in those tablets is not thought to be enough to have a real effect on the pain, so you are probably no better off taking those tablets than you are taking standard aspirin, ibuprofen or paracetamol.
They don't contain enough codeine to give you any additional pain relief, but there is enough to get you hooked.
Despite how dangerous pills can be, we still love them.
If I could invent a pill to do anything, I'd quite like one that could just put you to sleep for 15 minutes and you'd be completely refreshed when you woke up.
I'd invent one pill that covers the whole spectrum.
You just take one pill in the day and that's it.
You're good to go.
If I could invent a pill, it would be a thin pill with no horrible side effects.
I think mine would just have to be a general one for any very, very severe illness that people get.
Oh, that's nice, that's so much less selfish than me.
If I would invent any pill, it would be something that would cure everything and it would be called .
.
infection curer.
This love of pills is not without good reason.
They perform miracles on a daily basis, none more so than antibiotics.
I believe they're magic, yes, antibiotics.
I'm all for those.
Each of us will turn to them an average of 60 times.
They have been credited with increasing our lifespan by almost a decade, but our relationship with nature's great miracle is getting more fraught.
For a long time, bacteria have been fighting back.
Dr Vanya Gant has a patient who is battling for her life.
A treatment she's been receiving for cancer has left her vulnerable to infection and now the antibiotics she's been given aren't working.
Back in the lab, he needs to find out why.
What I can see here are organisms called streptococci, because they have a classic shape and a classic length, and they come in chains.
But that's not really quite enough for me to know exactly what this bug is, so we grow it on plates like this, and each of these dots has about a half-billion organisms in it.
These discs here have got antibiotics in them which leak out into the agar, and if you look at that one there, you can see there's a very, very, very, large zone of clearing and that's because that antibiotic is killing that organism, but if you look at all the others, there's no effect at all.
So this plate is telling us that my patient has got a highly resistant organism, and this explains why she's not doing quite as well as she should, so resistant to one, two, three, four, five antibiotics, sensitive to only one.
Our resistance to antibiotics is a problem that's only getting worse.
It may be that I could show you a plate like this in two years' time where not only all six fail, but the one I've got up my sleeve and in my head that I'm going to give her would also fail.
Organisms divide so fast, every 15 minutes, that within a day or two days, there will be billions of them.
You need one to learn how to get over the antibiotic and that's it.
It's game over.
Nature wins on this occasion.
Dr Gant has just one final antibiotic he can try.
But he also realises that with any antibiotic, there is a cost.
They actually make us more vulnerable to disease.
Because bacteria also have the power to protect us.
We would not be here without bacteria.
We need them, we can't live without them.
Within three hours of being born, we have bacteria already starting to thrive in our intestines and on our skin.
They make essential food for us in our large bowel.
They make us vitamins.
The natural state of affairs that has evolved over millions of years is one of an exquisitely fine balance between the bacteria that live on and in us, and ourselves.
Antibiotics that man has made have only been here for 70 years and they are so powerful.
That balance can with one tablet be completely wiped out.
Bacteria we carry with us work alongside our immune system, helping us fight off nastier bacterial invaders.
But a broad-spectrum antibiotic can't distinguish the more helpful bacteria from the harmful.
They all get killed in the mix, leaving you more vulnerable to other bugs.
The thing about antibiotics is that they're not like any other drug, that every other drug you take is for you and your body.
The antibiotics are not for you at all.
They're aimed at the bugs, and in fact, the better the antibiotic, the less effect it has on you.
But for Dr Gant's patient, Kathleen, these risks are far outweighed by their life-saving potential.
Hi there! Hi, I've come to see how you are today.
Well, I feel a lot better today.
Fantastic, fantastic.
In what way? I just feel more, erm, alert.
Getting back to normal, sort of thing.
The last one Dr Gant had left worked.
'In this lady's condition, 'she would have probably had less than 10% chance of surviving' had we not had an antibiotic to treat her infection, which is extraordinary, and that is close to a miracle.
'We can bring people back from the brink who would almost certainly have died from their infection.
' Despite this success, the question remains - how long can this miracle keep working? We're entering a revolution in medicine.
Today, pills don't just treat illnesses we have.
There are now pills for illnesses we may yet have, a pill not for disease but for the risk of disease.
Chief amongst them is a new class of drugs known as statins.
Millions of people could benefit from taking a drug that cuts cholesterol levels in the blood.
New research appears to show that a third of all heart attacks and strokes could now be avoided.
New research into the anti-cholesterol drugs known as statins offers hope to millions of heart patients.
Statins have been heralded as the greatest discovery since antibiotics, and their ability to deal with cardiovascular disease has made them the most prescribed medicine in the world.
In the UK alone, six million adults pop one every day.
Statins are fantastic drugs, no doubt about it.
They're life-savers.
We may not be sure HOW they do that but we know that they do.
So if you take a statin, your cholesterol level will drop.
If you take a statin, your risk of heart attack and stroke will fall.
Statins reduce the amount of cholesterol, also known as lipids, in the blood.
The Government recommends that statins be given to all those who have had a heart attack, a stroke or angina.
Mrs Parsons? Susan, come on in.
But now health officials are recommending statins be prescribed to those who are simply deemed to be at risk of a heart attack or stroke because their cholesterol is raised above normal.
That means what's normal is critical, and the way that figure is arrived at is causing some concerns.
'The "normal" level is one that 25-year-olds have.
' This became the "normal" level on the basis that people with lipid levels such as 25-year-olds have don't go on to have a heart attack and don't go on to have a stroke.
Setting the bar so low means most people fall into that category.
'Almost anyone over the age of 30 will have what appears to be raised lipid levels, 'will have what appears to be abnormal lipid levels,' will have a lipid level that becomes a problem for the doctor treating them for which the pill is the answer.
This would not be a problem but for the fact that statins, like all drugs, can have side effects.
'There's a huge number of people that go on these pills' whose lipid levels come down on the pills but whose quality of life gets worse.
They complain about muscle pain, they complain about fatigue, they complain about being forgetful.
They complain about a range of different problems that are being caused by the drugs.
You may have a choice - a shorter life or possibly a longer one that maybe isn't quite as much fun.
I get side effects.
You get a muscle problem where your muscles ache and sometimes you get cramps, but there are benefits.
You know they, they contribute to less strokes, for instance, so how do you balance it out? I don't know.
We are the guinea pigs, without a doubt.
But it's a trade-off many more of us may have to consider.
It has been proposed fairly recently that all men over the age of 50 and all women over the age of 60 should be taking a statin no matter what their cholesterol levels are as a blanket prescription to reduce their risk of heart attack and stroke in future.
For some, this widening of the net is just symptomatic of the way the pharmaceutical industry is moving.
From about 20 years ago or so, they moved from trying to produce drugs that treated real illnesses to drugs that treated risk factors.
Even those who soundly believe in the benefits of statins are wary of how medicine is changing.
In decades gone by, you would be assessed by your doctor.
You'd tell him your symptoms, he'd do the examinations, he'd do the lab tests and then you'd get the prescription and only then, whereas now the idea seems to be that "You're alive, you're breathing, you're 52.
"You'd better start taking the statins to lower your cholesterol level, "not because it's good for YOU but because it's good for everybody and you are part of everybody.
" Now that must be a drug company's dream, because if you've got a pill that's not designed to treat sick people but a pill that's designed for everybody, you must be onto a winner.
What we've moved from is a world in which we thought that drugs were poisons and the art of medicine was to make sure that the person had a reasonably serious condition that posed risks, that justified the risk we knew came with the pills, to a world where the drugs are now viewed as fertilisers.
They can do no harm if you just sprinkle them around the place widely.
I don't mind popping pills at all.
It doesn't bother me, it doesn't worry me.
I think I'm being kept alive artificially.
I think the biblical span of life tells you that at my age, one's usually, you know, gone.
I hate taking them, to be quite honest, if you want the truth.
I really hate taking pills at all because it's really against my grain that, you know, I'm needing to take them.
By the time you're in your 70s, you're likely to be taking at least five pills every day.
If it keeps me healthier than I would otherwise be, and hopefully mentally alert, then, you know, it's doing its job and thank you very much.
I believe in my heart that it's not good.
I don't think it's a good thing.
We're not meant to take them.
In the old days, they didn't take them.
They just died, you know.
I don't like it but I I am It's part of my life.
It IS my life, actually.
Millions of people turn to pills every day to prolong their lives, but there are some who believe medicine could also be used to bring it to an end, like John.
If there was such a thing as a simple pill that you could take, preferably with a large Scotch, and go to sleep and not wake up, a lot of people would prefer that, in fact would leap at the chance.
John is a member of Exit International, an organisation that aims to help people find a way to kill themselves in a dignified way at a time of their choosing.
I want to be able to have the choice, when I do feel it's necessary to take that choice, and I don't want to leave it either to nature or to somebody to sort of see me through my last few years in a state of misery in some sort of home.
I want to be able to decide where and when I go, and I want other people to have that right as well.
An overdose of anything will be fatal.
But what many Exit members want is a simple pill that can end their lives in a peaceful way.
But that's not as easy as it sounds.
No pharmaceutical company can entertain the idea, so a bunch of octogenarians have dug out their old high school chemistry books and are trying to create one, just for themselves.
Despite spending years and thousands of pounds on the project, the Exit chemistry group haven't yet created a solution.
But the search for what they call a peaceful pill goes on.
People have asked if it's wrong to use medicines which have kept us alive all our lives to bring an end to our lives.
I want us to have the choice, and if there are medicines or methods which we can use to do that, with dignity above all, then we want the right to make that choice.
One day, the peaceful pill could be the last of the 14,000 you may have taken, packets and packets of pills you've probably popped without even thinking, but should you be thinking about it more? You show me a drug with no side effects, I'll show you a drug with no benefits.
The difference between a drug and a poison is basically the dose.
It was so painful, I couldn't walk or I'd be violently sick and I got the shivers and my heart would race like crazy.
And I thought, "Christ, these are just painkillers," you know.
But medicines have the power to cure Oh! .
.
and improve the quality of our lives.
New drugs will be discovered There is a huge opportunity now, probably greater than ever before, to make a new raft of medicines.
.
.
and new uses found for drugs we already have.
But there's no escaping the truth.
We're all part of one big clinical trial.
Every patient who takes a drug is part of an experiment to see whether that drug is safe to use or not in the long term.
I have spent my entire career prescribing medicines of one sort or another to patients of every kind.
I honestly believe that for the majority of those patients, we've done more good than harm.
You just have to trust him.
Tiny little spheres of crushed powder with almost magical effects, pills that will possibly save and extend your life by decades.
Any medicine actually is a miracle.
If you really think about what a medicine does, that you can design a small chemical to interfere with a biological process to alter disease I mean, it is just astonishing that you ever get there.
These miraculous pills often owe as much to serendipity as science.
We started with a drug that we hoped would be effective in angina and we ended up with a medicine that was highly effective in erectile dysfunction.
This accidental nature of drug discovery means little is known about what they can do until we all take them.
In many ways you learn as much about your medicine after it's launched as you knew before.
The results of this process can be unsettling.
When you take a tablet, you're entering into a bargain.
Our side of the deal is that we honestly believe the tablet will do you more good than harm, but you have to accept the possibility that it may, in the long term, do you more harm than good.
We just don't know that yet.
Our relationship with pills starts from the very beginning of our lives, from the medicines handed to us by our parents.
I used to get so upset having to take these pain killers because I didn't want to, so my mum, I was probably about five, and my mum used to snap them in half and tip the actual medication into orange squash for me.
My mum gives me my tablets every day.
As we grow up, we begin to pop pills for everything.
There are the antibiotics we take to fight off disease, more than one course every two years of our lives.
The 28,000 pain killers we each take to make us feel better.
Pills to stop us having babies.
I actually got pregnant on the pill.
So Medicines to carry us through middle age.
Statins.
Simvastatin.
Simvastatin.
Even tablets to extend our youth and improve our performance in bed.
Yes, yes, I have used it.
The first month it came out.
By the time you're in your 70s, you'll probably be taking at least five tablets a day.
The pills we take define who we are.
Pills are just part of my everyday life.
And what we are.
I take a lot of pills.
Matter of fact, I take 15 a day to keep alive.
But they're not always beneficial.
We read through the back and I had every symptom on that packet.
How much do we really know about the pills we take? And can we trust them to do what they're supposed to? This is a temple to modern science - the pharmaceutical labs at GSK.
But modern drug discovery relies more on an automated lottery than careful design.
This store of chemical compounds is the company's crown jewels.
This is where their new drugs come from.
In here is a library of over two million nameless chemical compounds.
The scientists know very little about them.
They could be highly toxic, or they could be harbouring a life-saving drug.
It really is trying to find a needle in a haystack.
It is about getting the samples out, processing them, screening them and hoping we find that that chemical compound that is active against those disease areas.
This is where the lottery begins.
A known disease molecule, called the target, is introduced to each of the two million compounds, one by one, to see if anything happens.
With the two million or so compounds, we might get a few compounds that are active against that target.
We then have to take that one or two hits and the chemists will make hundreds, maybe thousands, of samples related to that original structure to try and improve the activity and most importantly try to negate any safety or undesirable effects.
We have to screen those over and over again to make sure that we're going in the right direction.
After hundreds of millions of tests, just a handful will make it through to trials on people.
In all, it takes about 1 billion and 15 years' work to find the winning compound that can become a licensed drug.
The journey to a medicine is an epic journey.
That whole process from idea through to a drug approved is one littered with failure.
Despite the minute success rate, the potential rewards are enormous.
We hope there would be chemicals in here that would be the future cures for all sorts of disease areas.
It would be nice to think that here we do have the cures for cancer, AIDS, malaria, any of the World Health Organisation top priorities.
If drugs are not designed but discovered, then it should come as no surprise that we only find out what they really do to us when we take them.
Give me your hand.
Give me your hand.
Liam! This is Liam.
Aged five, he was disruptive, hyperactive and unable to focus.
Liam, there's cars coming.
Straight here now! And this is Ed.
I've just finished my law exams for this year.
I've got a triathlon coming up in two days' time and I've got a couple of jobs on the go at the minute so things can be quite hectic.
It does sometimes feel like there aren't quite enough hours in the day.
Don't, Liam! For very different reasons, both Ed and Liam have found benefits from the same drug.
Aged five, Liam was diagnosed with attention deficit hyperactivity disorder, ADHD.
Come on, your hot chocolate's ready.
Now, five years later, Liam's life has been transformed.
Here you go.
Thank you.
One, two, three, four, five.
Excuse me.
Whose go is it next? Mine? No it was me, you His newfound ability to concentrate is largely thanks to a drug called methylphenidate, best known to most of us by a brand name - Ritalin.
It takes about 30-40 minutes for it to work, and it's not like Liam suddenly goes docile.
It just basically does have a calming effect on him.
He doesn't seem to be as hyperactive on the medication and he is able to sit quietly, be able to focus on things like his homework or just, just basically have a more normal life, really.
And, as for thousands of other children, Ritalin has had a remarkable effect on Liam.
I feel calm.
I don't feel like excited.
I feel energy because I can just run around all day if I wanted to but I'm just calm now.
And I'm excited as well.
Now without the medication, you could ground Liam and he would go back the next day and do the same thing that he'd been grounded for.
With medication it just enables him to consider the consequences, a little bit more clearly, of his actions.
It was only by accident that researchers discovered drugs like Ritalin could help children with behavioural problems concentrate better.
These drugs were originally designed 50 years ago for the treatment of adults with depression.
It's only now we are beginning to understand how they work.
ADHD is believed to be caused by an imbalance of key chemical messengers in the areas of the brain that control attention and working memory.
Ritalin appears to make these messengers more effective, helping to restore attention.
Like all drugs, Ritalin comes with a cost.
It can cause a loss of appetite and insomnia.
But now another benefit has been revealed from which we could all profit.
Initially when I took the Ritalin, I didn't feel any difference.
Only really afterwards did I actually notice that I felt slightly more focused than I usually do.
I found it really difficult to kind of get into that mental state where I kind of felt I could just sit and do nothing.
I found myself looking for things to occupy my attention.
Ritalin can work as a cognitive enhancer.
If a person without ADHD takes it, it can make them cleverer.
It's a discovery not lost on the country's academic elite.
Here at Cambridge University, students are abusing Ritalin or its close relative, modafinil, to help them get ahead.
A few of my friends do what they call modafi-vising.
It can keep them up for 24 hours and they can keep on going.
I think they feel pretty shocking after it, but if you need to do a lot of work in a short amount of time, then that's one way I've heard it can be done.
People who do take Ritalin, I think they see the benefits of it and it does help them with their revision.
My friends that do, tend to do pretty well but I, I like to think that's because they're quite clever.
Ed wasn't taking Ritalin for illicit gain.
He took it at the behest of this woman.
Barbara Sahakian is Professor of Clinical Neuropsychology at Cambridge University.
She's researching what drugs for those with ADHD can do to the brains of the healthy.
Well, we knew that the drug worked as a cognitive enhancer for conditions like attention deficit hyperactivity disorder, but would they also work in, in healthy people who didn't have any problems? Could we actually boost cognition in somebody who was you know functioning well? Ed was one of her research volunteers.
They were each given Ritalin and put through a variety of intelligence tests.
Not only were we able to show an improvement in their ability to do say a task like spatial working memory, but they also showed an increased efficacy in the neural networks in the brain that were required to perform that task.
Professor Sahakian found the drug had also boosted levels of chemical messengers in healthy brains, increasing their concentration levels too.
We were a bit surprised that in healthy people you could boost cognition.
It reveals ADHD is not a black and white disorder.
It's a spectrum, a spectrum we are all on.
Some people are very impulsive, other people are not impulsive at all.
I think we all know friends of ours who might do something that we wouldn't do and then it's a question of if we go further up that spectrum, that we may start to find somebody who is actually not functioning very well because their impulsive behaviour or their lack of attention is very bad and therefore they do actually need a treatment.
This potential to make us all cleverer opens an ethical minefield.
I think it is cheating because it's not your natural self.
If you want to do well, I feel that should be a personal achievement as opposed to enhanced by artificial mechanisms.
If a lot of people took it, then people would HAVE to take it to be able to compete with their peers.
To be perfectly honest, doing what it does, if it was legal, and it was safe, everyone would be doing it.
Already it's being put to use amongst professionals.
Professors are using it to help them work, and surgeons are looking at it as a way of staying alert during long and complex surgery.
But for Professor Sahakian the question remains - will it actually make our lives better? Suppose we took cognitive enhancing drugs and we got all our work done in a short period of time, we could go home, spend time with our family and improve our work/life balance.
That would be great.
But it's more likely with the type of society that we seem to be moving towards that it will be this 24/7 society so we'll take these drugs so we can work longer, so we can travel more and do more work so it will disrupt our work/life balance even more.
I'm always looking for ways that I can squeeze more in.
At one point I did think I'm going to have to give up eating, sleeping or one of my jobs.
It did cross my mind actually that if I could get my hands on something like that again, it would be, you know maybe to my advantage.
I'm not sure about a pill that would make you more intelligent.
We're happy being a bit on the thick side.
Yeah, being a bit thick's OK.
We'd like to think our drugs are designed for exact purposes, but they're not as targeted as we think.
We only discover where in our bodies they work when we take them.
It turns out Ventolin inhalers, a treatment for asthma, can also prevent premature labour, and arsenic, a notorious poison, is making a comeback as a treatment for leukaemia.
Even the fastest-selling drug of all time is not used for what it was designed.
It started life as UK 92480, one of millions of compounds in the stores at the drug company Pfizer.
They were looking for a new drug for angina, something that would relax blood vessels around the heart.
After screening hundreds of thousands of compounds, they ended up with UK 92480.
But its trials in humans were a let-down.
It was about to be consigned back to the stores when the trial volunteers started coming back and reporting an unusual side-effect - lots of erections.
Add the drug the relaxation's get larger but its trace is upside down.
By making a crude mock-up of the human sexual apparatus, senior scientist Chris Wayman found an ingenious way to test this anecdotal evidence.
These are actually penile blood vessels that we have in a tissue bath.
Think of this as the brain.
This is the brain and the spinal cord.
When you're becoming aroused, your brain switches on.
We can mimic this by switching on the equivalent of the central nervous system in the brain.
It sends electricity down to the tissue bath and across the tissues, and when we pass an electric current across these small pieces of penile tissue, they relax and ultimately that's what happens during penile erection.
Relaxed penile blood vessels mean more blood flow to the penis, and so an erection.
What Chris did was take penile blood vessels from impotent men, vessels that didn't respond when he flicked the brain switch, and then added UK 92480 to the tissue bath.
What was most amazing about this study was that we saw a restoration of erectile response.
It's very rare in any tissue preparation to convert dysfunctional to normal function, and so now we were really onto something that could only be described as special.
At the time there was no oral treatment for erectile dysfunction.
No-one even really knew what caused the problem, but suddenly Pfizer had a potential treatment on their hands.
When this data was shared with the experts in the field, the urologists, they were astounded.
I remember a meeting in America at the Urological Association where the room was packed when this data was released because no-one had seen anything like this before.
UK 92480 was renamed Viagra, and within weeks of going on sale, tens of thousands of prescriptions were being written every day.
You would never have been able to predict that this was going to have beneficial effects on millions and millions of men throughout the world, a little bit of science having effect on self-esteem, anxiety, depression levels and ultimately creating enhanced relationships.
Viagra is now one of the most prescribed drugs in the world.
Six tablets are dispensed somewhere every second.
But some have begun to ask whether so many men need it.
When it first came out, it was definitely seen as a medical drug for a chronic condition, a medical condition, but obviously they suddenly became aware of a huge market capacity.
They began to market it to men who occasionally didn't have an erection as opposed to consistently didn't have an erection, and the message shifted from being, "This is for you if you're ill with another health problem", to, basically, "You can always have great sex.
" Viagra wasn't the only one to do this.
I mean, the other sex drugs like Levitra and Cialis that came on slightly later all use a similar marketing strategy.
Pfizer claims more than half of all men over 40 have difficulties getting or maintaining an erection.
But this figure is not universally accepted.
We estimate it's around 9% of men who have it as a chronic condition, and that's usually linked to older men and men who have got other health problems.
In terms of men occasionally having problems with erections, most men would actually probably do that and that's quite normal.
The implication is that if you're falling short of 100% perfection, that, you know, the pill may be able to help and, in essence, this means that you're ill.
But of course being 100% perfect is not normal.
This is not the normal state.
Being normal means being slightly different from one day to the next.
Pfizer stands by its claim.
But this throws open the question, what is a medical condition? The latest target is women with a low sex drive.
It's even got a medical term - female sexual dysfunction.
Already the race is on between drug companies to find a cure.
But is not wanting sex necessarily a medical disorder? The idea that you categorise a problem of female sexual dysfunction or FSD, I think is the best example we've ever had of creating a market for a disease and kind of creating a disease out there where none existed before.
Because if you think about it, a lot of women would say they don't want sex very much because they're tired or they've got low self-esteem.
There's a joke we make which is if you can create a pill that would make your partner do the housework, it would probably be more beneficial than giving women a drug that would actually boost their sex drive.
Pills and sex can be a lucrative combination.
But sometimes drug companies are not the first people to see that.
In the UK, one third of all women of reproductive age take the contraceptive pill.
Worldwide, a hundred million rely on it, but it almost never reached the market.
In the 1950s, research into contraception was illegal in many parts of the world and where it was legal, pharmaceutical firms feared a moral backlash.
Despite this, independent researchers did discover how to synthetically create female hormones.
They realised giving these to women as a pill would change their fundamental biology and stop them ovulating, preventing them from getting pregnant.
Pharmaceutical companies were reluctant to back the project, so when one did get behind it, the pill was brought to the market as a drug for heavy periods, but women soon cottoned on to its real potential.
It's just allowed people to manage their fertility and their families, and has liberated people in that sense.
In the past, a lot of people were stuck with families that were getting bigger and bigger because they just couldn't stop babies from coming, and really within the last sort of 40, 50, 60 years we've been able to manage that and have the families of the size that we want, which has led to healthier children and happier families.
The result was a social revolution.
On the male side however, contraception hasn't changed since rubber condoms and vasectomies were invented in the 19th century.
Men still don't have a pill of their own.
What's stopping it is a question of numbers.
To produce effective contraception for a man by suppressing the sperm production, you need to suppress something like two hundred million sperm from being produced from the testes every day, and that is quite a big challenge compared to suppressing the production of one egg every month in a woman.
Now, after years of research, Professor Fred Wu and his team have found a way to prevent so many sperm being produced, giving men powerful sex hormones, tinkering at the heart of what makes a man a man.
It switches off the hormones from the pituitary gland, so basically the testes stop working.
It's put to sleep.
Unsurprisingly, this process has a major side effect - the very emasculation of the patient.
In order to restore their manhood, some more hormone altering is needed.
At the same time we're giving back the testosterone, so that the male features and the male characteristics are fully preserved.
The result, in theory, is a fully functioning man, just without sperm.
It may sound extreme, but it's no more radical than what millions of women endure.
But Professor Wu is finding it hard to get the backing of a pharmaceutical company.
It seems times have changed.
We are now more wary of meddling with our bodies than 50 years ago.
If the female contraceptive pill was developed from scratch now, it would probably come across exactly the same difficulties as we are at the moment.
Professor Wu remains undaunted.
There is definitely a potential market for it, and I think once a product like this is marketed, it may well lead to changes in attitudes, social changes, similar to what happened with the female pill and then I think it is likely to lead to a much larger market than the companies think there is at the moment.
There is one problem Professor Wu can't solve.
When it comes to pregnancy, the stakes will never be as high for men as they are for women, and with that comes a question of trust.
I just don't think they'd do it.
I think it's something that men tend to rely on women to do and take the responsibility of.
No offence, guys.
If you met somebody, a man, and he just said, "Oh, it's all right, I take the contraceptive pill," I'm not sure I'd be willing to believe that.
But then I dare say there's some women that you can't trust to take it.
I don't think it's just men.
Well, absolutely, yeah.
I'd probably be standing over him watching him take it so They can't even put socks on in the morning, you know, how are they going to take a pill at the same time every day? Pills don't just affect our bodies.
They can treat our minds, and sometimes finding a successful medicine for an illness can even change the way we view ourselves.
Depression is a case in point.
In the 1950s, depression was a strictly private affair.
Those that sought help got little in return.
The few drugs that were on offer were unlikely to lift your spirits.
You would have dry mouth, blurred vision, problems passing urine.
You'd feel knocked out and dopey.
It would be barely better than the situation you were actually in to start with.
It all changed when a new wave of drugs came along.
Scientists had realised that a brain chemical, serotonin, affects our mood.
If they could find a way to boost the amount of serotonin in the brain, it could improve our sense of wellbeing.
They tested hundreds of compounds and managed to create a new class of drugs that had a fraction of the side effects of the older anti-depressants.
This group was termed selective serotonin re-uptake inhibitors, SSRIs.
Soon they were known simply by the brand name of the first one on the market, Prozac.
Suddenly depression had become a treatable condition, and that made it more socially acceptable.
If you have an effective treatment for a condition, people who suffer from that condition will come out of the woodwork and you'll find more often that, build it and they will come.
By the 1990s, the number of people coming forward seeking treatment tripled.
Soon SSRIs were a solution to everything.
Back in those days, if you came into a GP's surgery looking a little bit glum cos someone stole your bike or your dog died, you'd be assessed as being depressed and be given anti-depressants.
Way overkill.
Everyone now admits that was true.
In time, the tide began to turn against SSRIs.
As more and more people took them, some disturbing serious side effects began to emerge.
The risks are that approximately one in five people will become much more anxious on these drugs, that one in 100 or so will go on to a suicidal act, that one in the area of something like 500 to 600 people may go onto complete suicide, who wouldn't have done so if they hadn't been on the pills.
One drug in particular came under scrutiny.
The makers of the controversial anti-depressant drug Seroxat have been criticised by the health care regulatory body for withholding information about the risk of suicidal behaviour associated with the drug.
In 2006, GSK, the makers of Seroxat, one of these SSRIs, admitted that Seroxat raised the risk of suicide eight times.
Sadly, side effects from drugs are nothing new.
Thalidomide was the great drugs disaster of the post-war era.
Given to expectant mothers with morning sickness in the late 1950s, it was not long before its devastating side effect became clear.
It was withdrawn in 1961 and brought with it new trials procedures that were supposed to prevent anything like it happening again.
But they haven't.
There are warnings that a drug used worldwide by millions of people with arthritis could increase the risk of heart attacks and strokes.
Doctors have been told to stop prescribing a drug commonly used in the battle against obesity.
The benefits no longer outweigh the considerable risks.
In the last five years, in the UK alone, eight drugs have been withdrawn from the market by the regulators.
The anti-obesity drug, Rimonabant, was banned because it could cause suicide.
Vioxx, used to treat rheumatoid arthritis and menstrual pain, was withdrawn after it caused 140,000 heart attacks in five years.
The discovery of undesired effects is, however, intrinsic to the experimental nature of medicine.
Clinical trials are done on thousands of people, but some side effects are only found when hundreds of thousands take them, when the drug comes to the market.
You might start picking up side effects that you couldn't have anticipated, that you didn't know, that are relatively rare but nonetheless can sometimes be important.
Drug development is an ongoing clinical trial in which we all play a part.
There's no such thing as a totally safe medicine.
There's no such thing as a medicine that we know absolutely everything about and therefore there is some uncertainty, and that persists.
Because this goes to the heart of what medicines are.
When you make a medicine, you're trying to disrupt a fundamental biological process.
That's a pretty profound change.
You can't do that without producing some unwanted effects.
So then the question is, what risk are you prepared to take for what benefit.
Side effects are not restricted to the dangers written on the back of the packets.
For hundreds of thousands of people, the thing that set out to be the solution has become the problem itself.
I'm thinking, "Oh, lovely", then I think, "I've got to have my tablets", I just want this uncomfortable feeling to start going, really.
That's all I want it to do.
These used to be my best friends.
They're not now.
I hate them.
Jo Palmer is addicted to pain killers.
It changes your personality totally.
You know ,I hated the person that was emerging from it and I still do.
Jo's addiction started 18 years ago when she was prescribed strong pain killers to deal with chronic pain.
But by the time she'd been cured, she found she couldn't function without the drugs.
Over the years, the addiction has taken over her life, causing pain itself, limiting what she can physically do.
Jo has struggled to overcome her addiction but she can't escape it.
The problem is that she can score her drugs on the high street.
There is quite a lot of chemists when you look round, and you go in and you do it on a rota system, so one chemist thinks that you're just getting them once per week.
But then you drag people into it and you don't mean to.
But you, you know, when I asked my husband to get them for me, he honestly said to me, "I can't, I can't go in there and get them for you.
"It would be like dealing to you.
You know, "this could be the one that kills you and I'd never forgive myself.
" Jo is still battling her addiction.
The drug she craves is the codeine in extra-strength pain killers.
Codeine is an opiate, the same family of drugs as class A street drug heroin.
As well as killing pain, codeine gives a feeling of calm, of wellbeing, that can be more attractive than the pain-killing itself.
It is incredibly easy to get addicted to pain killers and there's an epidemic, that's not too strong a word, of usually women out there, who are entirely dependent on codeine-based pain killers.
But just like any drug, you build up tolerance and it's this that lies behind the addiction.
The more you take, the less effect it tends to have.
So you start out taking a small dose.
You need a bigger dose and a bigger dose and you finally end up in a sort of vicious circle where you have to keep increasing the dose over and over, to get the same effect in terms of pain relief.
I was at 70 a day.
If I gave it to you, or anybody else, it could kill you.
Me, I'm not saying it can't kill me.
I am at risk of that, but my body has been more used to it than you.
It's not just pain killers.
Many medicines have the power to lure us in.
I had a situation where I kept waking during the night and I couldn't go back to sleep.
I tried everything I could, so basically I went to see the doctor and I explained to her what the problem was.
The tablets that she prescribed me was only a short-term thing, six to eight weeks, and I've been on them for about 20 years, something like that.
When I was on steroids, when I was a lot younger, I can always remember looking at them thinking, "Can I actually give them up? When I'm in pain, what am I going to do, what am I going to take?" Gradually, as the years went by, I began to realise that I was seriously addicted and I just needed more and more.
I couldn't get off them.
I can remember my mum tipping them down the sink, saying, "You can't have any more.
" And once I got it in my head that I could, I could do without them, I was fine.
I feel great now.
I feel absolutely great.
I'm drug free.
Jo reached rock bottom in 2006 and has been trying to turn her life around since then.
She's on the slow road to recovery, battling against withdrawal symptoms of nausea, pain and anxiety if she cuts down too quickly.
I've got it under control now, to about anything from ten to 20 a day, on average.
Who's a good boy?! 'It's to keep off the withdrawals.
' Drop it there! Good boy! I live day for day.
And I hope, one day, that so many will go down to so many, and then go down.
I don't ever give up trying.
But many people question whether codeine even needs to be in these over-the-counter drugs in the first place.
One of the things about the over-the-counter pain killers that contain codeine with aspirin or paracetamol or ibuprofen is the amounts of codeine in those tablets is not thought to be enough to have a real effect on the pain, so you are probably no better off taking those tablets than you are taking standard aspirin, ibuprofen or paracetamol.
They don't contain enough codeine to give you any additional pain relief, but there is enough to get you hooked.
Despite how dangerous pills can be, we still love them.
If I could invent a pill to do anything, I'd quite like one that could just put you to sleep for 15 minutes and you'd be completely refreshed when you woke up.
I'd invent one pill that covers the whole spectrum.
You just take one pill in the day and that's it.
You're good to go.
If I could invent a pill, it would be a thin pill with no horrible side effects.
I think mine would just have to be a general one for any very, very severe illness that people get.
Oh, that's nice, that's so much less selfish than me.
If I would invent any pill, it would be something that would cure everything and it would be called .
.
infection curer.
This love of pills is not without good reason.
They perform miracles on a daily basis, none more so than antibiotics.
I believe they're magic, yes, antibiotics.
I'm all for those.
Each of us will turn to them an average of 60 times.
They have been credited with increasing our lifespan by almost a decade, but our relationship with nature's great miracle is getting more fraught.
For a long time, bacteria have been fighting back.
Dr Vanya Gant has a patient who is battling for her life.
A treatment she's been receiving for cancer has left her vulnerable to infection and now the antibiotics she's been given aren't working.
Back in the lab, he needs to find out why.
What I can see here are organisms called streptococci, because they have a classic shape and a classic length, and they come in chains.
But that's not really quite enough for me to know exactly what this bug is, so we grow it on plates like this, and each of these dots has about a half-billion organisms in it.
These discs here have got antibiotics in them which leak out into the agar, and if you look at that one there, you can see there's a very, very, very, large zone of clearing and that's because that antibiotic is killing that organism, but if you look at all the others, there's no effect at all.
So this plate is telling us that my patient has got a highly resistant organism, and this explains why she's not doing quite as well as she should, so resistant to one, two, three, four, five antibiotics, sensitive to only one.
Our resistance to antibiotics is a problem that's only getting worse.
It may be that I could show you a plate like this in two years' time where not only all six fail, but the one I've got up my sleeve and in my head that I'm going to give her would also fail.
Organisms divide so fast, every 15 minutes, that within a day or two days, there will be billions of them.
You need one to learn how to get over the antibiotic and that's it.
It's game over.
Nature wins on this occasion.
Dr Gant has just one final antibiotic he can try.
But he also realises that with any antibiotic, there is a cost.
They actually make us more vulnerable to disease.
Because bacteria also have the power to protect us.
We would not be here without bacteria.
We need them, we can't live without them.
Within three hours of being born, we have bacteria already starting to thrive in our intestines and on our skin.
They make essential food for us in our large bowel.
They make us vitamins.
The natural state of affairs that has evolved over millions of years is one of an exquisitely fine balance between the bacteria that live on and in us, and ourselves.
Antibiotics that man has made have only been here for 70 years and they are so powerful.
That balance can with one tablet be completely wiped out.
Bacteria we carry with us work alongside our immune system, helping us fight off nastier bacterial invaders.
But a broad-spectrum antibiotic can't distinguish the more helpful bacteria from the harmful.
They all get killed in the mix, leaving you more vulnerable to other bugs.
The thing about antibiotics is that they're not like any other drug, that every other drug you take is for you and your body.
The antibiotics are not for you at all.
They're aimed at the bugs, and in fact, the better the antibiotic, the less effect it has on you.
But for Dr Gant's patient, Kathleen, these risks are far outweighed by their life-saving potential.
Hi there! Hi, I've come to see how you are today.
Well, I feel a lot better today.
Fantastic, fantastic.
In what way? I just feel more, erm, alert.
Getting back to normal, sort of thing.
The last one Dr Gant had left worked.
'In this lady's condition, 'she would have probably had less than 10% chance of surviving' had we not had an antibiotic to treat her infection, which is extraordinary, and that is close to a miracle.
'We can bring people back from the brink who would almost certainly have died from their infection.
' Despite this success, the question remains - how long can this miracle keep working? We're entering a revolution in medicine.
Today, pills don't just treat illnesses we have.
There are now pills for illnesses we may yet have, a pill not for disease but for the risk of disease.
Chief amongst them is a new class of drugs known as statins.
Millions of people could benefit from taking a drug that cuts cholesterol levels in the blood.
New research appears to show that a third of all heart attacks and strokes could now be avoided.
New research into the anti-cholesterol drugs known as statins offers hope to millions of heart patients.
Statins have been heralded as the greatest discovery since antibiotics, and their ability to deal with cardiovascular disease has made them the most prescribed medicine in the world.
In the UK alone, six million adults pop one every day.
Statins are fantastic drugs, no doubt about it.
They're life-savers.
We may not be sure HOW they do that but we know that they do.
So if you take a statin, your cholesterol level will drop.
If you take a statin, your risk of heart attack and stroke will fall.
Statins reduce the amount of cholesterol, also known as lipids, in the blood.
The Government recommends that statins be given to all those who have had a heart attack, a stroke or angina.
Mrs Parsons? Susan, come on in.
But now health officials are recommending statins be prescribed to those who are simply deemed to be at risk of a heart attack or stroke because their cholesterol is raised above normal.
That means what's normal is critical, and the way that figure is arrived at is causing some concerns.
'The "normal" level is one that 25-year-olds have.
' This became the "normal" level on the basis that people with lipid levels such as 25-year-olds have don't go on to have a heart attack and don't go on to have a stroke.
Setting the bar so low means most people fall into that category.
'Almost anyone over the age of 30 will have what appears to be raised lipid levels, 'will have what appears to be abnormal lipid levels,' will have a lipid level that becomes a problem for the doctor treating them for which the pill is the answer.
This would not be a problem but for the fact that statins, like all drugs, can have side effects.
'There's a huge number of people that go on these pills' whose lipid levels come down on the pills but whose quality of life gets worse.
They complain about muscle pain, they complain about fatigue, they complain about being forgetful.
They complain about a range of different problems that are being caused by the drugs.
You may have a choice - a shorter life or possibly a longer one that maybe isn't quite as much fun.
I get side effects.
You get a muscle problem where your muscles ache and sometimes you get cramps, but there are benefits.
You know they, they contribute to less strokes, for instance, so how do you balance it out? I don't know.
We are the guinea pigs, without a doubt.
But it's a trade-off many more of us may have to consider.
It has been proposed fairly recently that all men over the age of 50 and all women over the age of 60 should be taking a statin no matter what their cholesterol levels are as a blanket prescription to reduce their risk of heart attack and stroke in future.
For some, this widening of the net is just symptomatic of the way the pharmaceutical industry is moving.
From about 20 years ago or so, they moved from trying to produce drugs that treated real illnesses to drugs that treated risk factors.
Even those who soundly believe in the benefits of statins are wary of how medicine is changing.
In decades gone by, you would be assessed by your doctor.
You'd tell him your symptoms, he'd do the examinations, he'd do the lab tests and then you'd get the prescription and only then, whereas now the idea seems to be that "You're alive, you're breathing, you're 52.
"You'd better start taking the statins to lower your cholesterol level, "not because it's good for YOU but because it's good for everybody and you are part of everybody.
" Now that must be a drug company's dream, because if you've got a pill that's not designed to treat sick people but a pill that's designed for everybody, you must be onto a winner.
What we've moved from is a world in which we thought that drugs were poisons and the art of medicine was to make sure that the person had a reasonably serious condition that posed risks, that justified the risk we knew came with the pills, to a world where the drugs are now viewed as fertilisers.
They can do no harm if you just sprinkle them around the place widely.
I don't mind popping pills at all.
It doesn't bother me, it doesn't worry me.
I think I'm being kept alive artificially.
I think the biblical span of life tells you that at my age, one's usually, you know, gone.
I hate taking them, to be quite honest, if you want the truth.
I really hate taking pills at all because it's really against my grain that, you know, I'm needing to take them.
By the time you're in your 70s, you're likely to be taking at least five pills every day.
If it keeps me healthier than I would otherwise be, and hopefully mentally alert, then, you know, it's doing its job and thank you very much.
I believe in my heart that it's not good.
I don't think it's a good thing.
We're not meant to take them.
In the old days, they didn't take them.
They just died, you know.
I don't like it but I I am It's part of my life.
It IS my life, actually.
Millions of people turn to pills every day to prolong their lives, but there are some who believe medicine could also be used to bring it to an end, like John.
If there was such a thing as a simple pill that you could take, preferably with a large Scotch, and go to sleep and not wake up, a lot of people would prefer that, in fact would leap at the chance.
John is a member of Exit International, an organisation that aims to help people find a way to kill themselves in a dignified way at a time of their choosing.
I want to be able to have the choice, when I do feel it's necessary to take that choice, and I don't want to leave it either to nature or to somebody to sort of see me through my last few years in a state of misery in some sort of home.
I want to be able to decide where and when I go, and I want other people to have that right as well.
An overdose of anything will be fatal.
But what many Exit members want is a simple pill that can end their lives in a peaceful way.
But that's not as easy as it sounds.
No pharmaceutical company can entertain the idea, so a bunch of octogenarians have dug out their old high school chemistry books and are trying to create one, just for themselves.
Despite spending years and thousands of pounds on the project, the Exit chemistry group haven't yet created a solution.
But the search for what they call a peaceful pill goes on.
People have asked if it's wrong to use medicines which have kept us alive all our lives to bring an end to our lives.
I want us to have the choice, and if there are medicines or methods which we can use to do that, with dignity above all, then we want the right to make that choice.
One day, the peaceful pill could be the last of the 14,000 you may have taken, packets and packets of pills you've probably popped without even thinking, but should you be thinking about it more? You show me a drug with no side effects, I'll show you a drug with no benefits.
The difference between a drug and a poison is basically the dose.
It was so painful, I couldn't walk or I'd be violently sick and I got the shivers and my heart would race like crazy.
And I thought, "Christ, these are just painkillers," you know.
But medicines have the power to cure Oh! .
.
and improve the quality of our lives.
New drugs will be discovered There is a huge opportunity now, probably greater than ever before, to make a new raft of medicines.
.
.
and new uses found for drugs we already have.
But there's no escaping the truth.
We're all part of one big clinical trial.
Every patient who takes a drug is part of an experiment to see whether that drug is safe to use or not in the long term.
I have spent my entire career prescribing medicines of one sort or another to patients of every kind.
I honestly believe that for the majority of those patients, we've done more good than harm.
You just have to trust him.