Worldbuilding 203: Designing Medicine
Greetings and squab! You know… you’re not allowed to say that anymore… sorry! Anyway, it is now may and we are FINALLY, I hope, out of the sickness season. Funny story, in sweden we call February for “Vabuary” due to the sheer amount of kids gettings sick then after the holidays. Vab = “Vård av barn”, which means “Care of sick kid”. So how about we grab some medicine and try to not get sick?
Definition
What better way to start a blogpost other than a definition?
Medicine is any substance–gas, liquid, or solid–that is introduced into the body in order to help cure the body of some ailment.
And the crucial part is that it is inside the body. Why? Because if it is outside, it is definitionally not part of your system. Some, not going to name any names, ANNE, might point out then, “What about creams and such that you apply on your skin?” Well, dear reader, where does it go when it is on your skin? If it stays on your skin, it will never do anything to you because that is the whole purpose of the skin. Keep things out so they don’t interfere with the workings of the body. The body is unfortunately and fortunately not 100% good at its job, so a lot is still absorbed into the body, where the substance can start doing its magic.
Typical medicines
What are the types of medicines? One can broadly define it into two categories, though one was created in the last 100-150 years.
Natural medicines
Nature is great. Life has existed for almost 4 billion years, and multicellular life for 500 million years. With trillions of lifeforms all over the world. So in the enormous space of chemistry, nature and life has had a lot of time and attempts to explore. Life has literally billions and trillions of different chemical compounds that can then be used by a sophont species to help itself.
And these are often called natural medicines because they come from nature, and the chemistry has been stable for a long time. A quick side note for all readers: I want to make it clear that natural medicines are not inherently better or worse than the next category. All medicines, regardless of source, can do good but also cause great harm. And a lot of artificial medicines were once natural medicines that humans then learned how to mass produce in artificial ways.
Artificial Medicines
As the name suggests, these don’t come from what we would call natural sources. Though that is not entirely true, either. The space of all possible chemicals is absolutely enormous. And do you honestly think we humans have any time to search that space? Of course not! If we are going to search it randomly, we’ll be here for ages without ever finding anything.
So humanity takes the easy way of looking at nature and finding what it has and then going for it. If nature has already established a good and functional medicine, we try to find a way to mass produce it because nature is good at testing at large scale, but to produce it at a scale where millions or billions of people need it? Nature is rather terrible at that, so we try to find other ways to produce it. And keep in mind, as long as the chemical composition and structure is identical, natural and artificial medicine are of equal quality.
A different thing that can happen is this little story of Ozempic. They are not sponsoring this blogpost. It is based on a hormone that the human body has, but the human version is rather terrible because it is produced and then 5-10 minutes later it is gone, and you can get hungry again and start omnoming food. It does its job, but if you have weight control issues, it is not doing it well enough. Scientists found a similar hormone in a lizard that, when the humans injected it, the chemical lasted for HOURS instead. The human body took much longer to break it down, yet it triggered the exact same response as our natural body’s hormone production.
A massive upgrade… But who wants to inject that 2 to 3 times a day? Well, sometimes it is worth it, but it does lower people’s willingness to use it. So scientists started to think “Can we modify it so it lasts even longer?” We already had it proven how it could last longer and do the same function in the body. But can we make it do it even further? The answer turned out to be yes.
So a lot of artificial medicines are in fact natural medicines that are modified to be better at what they do and what we want them to do. Why reinvent the wheel when we cannot even figure out what a circle is, when we can find them lying around?
Other categorisations
Another way to divide medicine up, other than by chemical families, is in fact how it is administered. You have topical ones for the skin where it is absorbed through the skin. You have oral for those that you take through the mouth. Anal for those that go the other direction. And vaginal for those that have that alternative 🙂 You also have injection and intravenously. Both go straight into the body, but the latter straight into the blood stream. These two are also the ones most likely to cause infections as it involves breaking the skin in order to access what is underneath.
Finding medicines
I spoke of the quest to find medicines, and it is a herculean task. I said the chemical space is enormous. Let me illustrate how enormous it is with some quick math. There are 20 amino acids that exist. They come in chains to form proteins, and proteins are the work horses in the body that do everything in the body. In a chain of 100 amino acids–a fairly small protein mind you–that is 10 to the 120th power possible amino acids chains. That is a mind bogglingly enormous number, but how much is it? Well, let’s put it like this, if we take every proton, every neutron, every electron in the universe, and count them, we get a 1 followed by 80 zeros. That is 40 zeros less than our number… Do you see the problem now?
So let’s be honest, it is essentially dumb luck to stumble on chemicals that turn out to be good. We need to find whatever potential medicine that exists, we need to find people that can react to it, because not everyone will, and we need to find it in enough quantity that we can test it and it isn’t random fluctuation.
And the story behind it can be incredibly stupid. I can imagine some random teenager stuffing their face with something that no sane person would eat, because teenagers do stupid things, and somehow discover, “Oh this is a medicine!” and then everyone uses it and the teenagers are still blamed for the never ending fall of civilisation even though it keeps ascending.
An example discovered long ago was a way to clean wounds! Wounds can get infected and disgusting and then, then you are royally effed in the old days. But they had figured out that if you take moldy disgusting bread and rub it on the wound, it can help you! It was wildly inconsistent but hey… You had little to lose, you were going to die anyway. Now why did that work? Because some of the mold would be the same fungi that produces penicillin–you know, the antibiotic!
Side effects
A thing to remember is this, and I have said this earlier, there is no such thing as side effect free medicine! Sometimes the side effects are incredibly mild to the point where we don’t even count them, but they are there.
One might ask, why do side effects exist? Your body is a complicated network of chemical pathways where chemical reactions happen all over the place constantly, and every reaction triggers more reactions elsewhere, and it cascades outward in endless feedback cycles. Now, we introduce something new into this system that starts affecting some of the reactions elsewhere… and of course then it will start doing things. Yes, it will, if designed properly, do exactly what it should. But a thing to keep in mind is this, because the introduced chemicals (yes, even natural medicines are chemicals) are almost never 1-1 exact copies of what our body is producing, that means their structure is slightly different.
And in chemistry, structure is everything. So even a slight difference can mean it does 99% of the job we want, but then it does something else too that cascades outward to do other things. Or that slight difference means another part of the body is also reacting to it.
An example is thalidomite. It was a medicine for morning sickness in pregnant afabs (assigned female at birth), which is extremely unpleasant. But before I continue this story I need to explain the concept of chirality. It essentially means “mirror image”. If you look at your hands, you cannot move in space, twist and turn your right hand so it overlaps perfectly with the left hand. It is impossible because they are mirror images. And molecules can be the same and when it comes to biological molecules, there is almost always a chirality version of the molecule.
In a lot of cases, the chiral version of a molecule will simply ignore the body. It cannot “grab” it in any meaningful way. Thalidomite turned out to be different. One version did the job we wanted, it alleviated the morning sickness and did it well! And for an adult, the chiral version did nothing…for a developing embryo it turned out that chiral version interfered strongly with crucial proteins during those sensitive developmental phases and caused severe birth defects. It took a while but eventually the culprit was recognised. But this was a massive scandal.
So when you design medicines, you should always think about side effects… But you rarely need to consider chemical structures because… it often feels very random so you can just make them up as you see fit. And another thing to keep in mind is this: side effects are not universal. Some people will DIE because of a medicine… Others who take it are cured easily from the ailment they have. It is just that usually when we do a medicine, a large fraction of the population is generally responding well.
The liver
I have to bring this one up because this organ is so good at doing its job that it is a little bitch when it comes to medicine. The liver's job is to break down unwanted chemicals into preferably harmless, but not always (thanks methanol), and more water soluble components so the kidneys can make us pee it all out. And it does this to ANYTHING that comes through it, and anything that is orally taken has to go by the liver before it can do anything.
So any oral medicine you take will encounter the liver, and that bastard of an organ can destroy 90, 95%, sometimes even more, of the medicine taken, and it is the rest that goes into the bloodstream and can do the job. That is why, if you ever look, oral medicine dosages are substantially higher than anything taken any other way. Analy and vaginally are in some ways preferred because the liver gets no say in the deal then.
A personal anecdote of this. When I was starting on my hormones, I started on tablets for estrogen, and guess what? My liver was gobbling up all that estradiol I was taking like it was overly sugared candy. So it just did not work for me… So skin gel it was, and then all worked. As you can imagine… I was not too happy with my liver.
Certain fruits, and certain habits, can severely limit the liver's ability to decompose medicine so unless that is looked into, the medicine amount in your body can shoot up and as I said in my poison post, the quantity makes the toxin. And that goes for medicine as well. Too much medicine, and that is a poison killing you.
Ethics of medicine
Medicine should be ethical to use, right? Well, there is the ethics of using medicine and the ethics of acquiring medicine. Any medicine requires it to be tested on humans. How else would we know if it works? And this is where a lot of ethical issues come in. Humans have many times tested medicines on unsuspecting victims. I will call them victims because to be a test subject, I view it as it must be consensual and informed consent at that.
But historically, we’ve justified testing on unwilling people through various forms of bigotries, ableism, racism, misogyny, and much else. The worst times we have done it is when the victim knows they are being tested on, but is being forced to endure it against their will a la Dr. Mengele or Unit 731 in Imperial Japan. Even in the West there has been unethical medical practices due to sheer willful ignorance. Afabs were not tested for a lot of diseases and drugs. They just assumed if it works on an amab (assigned male at birth) then it works on afab identically… but that is not how science works.
One example is a test that had 100% amabs in it, and what were they testing? FOR THINGS RELATED TO THE UTERUS! I kid you not, all participants did not have a uterus yet the entire research was about uteruses… “Women are just men with pesky hormones causing noise” 🤮 as they said! That is why you test on all people!
Then we have ethical use of medicine. Which again fails a lot because of sheer bigotry. Doctors don’t listen to the patients or make assumptions based on the race, gender, queerness of the person rather than trying to treat the individual. They forget the hippocratic oath,
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
An interesting version of this though was in a Stargate Atlantis episode on a planet. That series is about aliens named Wraith who eat and consume humans like vampires in a cyclic fashion every few centuries. A civilisation had through these many cycles eventually managed to develop a vaccine so they could not be consumed.
Side effects included a 30-50% chance of death if I remember correctly. After a vote by the people, they decided to use it on the entire civilisation’s population, for those who wanted it only. 80% approval, and they went ahead. It raises many interesting ethical questions here that I do not know the answer to.
Summa Summarum
Medicines are methods to cure ailments, they can be psychiatric, physiological, bacterial, hormonal, viral, and many others. But it is important to remember that there is a process to acquire the medicine, to learn that it works, and how to use it. It is an incredibly long journey rife with ethical dilemmas.
And it is equally important to remember that any medicine you have must have side effects. There exists no panacea cure because no medicine can interact in the body, without SOMETHING else also interacting with it. The body is complex, incredibly complex… and an enormous pain to deal with. Yet somehow this bloody thing works, and medicines mostly work.
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