A few days ago, I gave a talk at the public library in Belvedere, California. It was a Tuesday evening, and the audience of 50 or so were mostly older folks - over 60-ish - with a smattering of younger adults. They were there to hear stories about drugs - and to talk about the drugs they take. Because they had questions. And concerns.

Were they on the right medicine?

Why wasn’t their medicine working?

Was there something else they should be trying?

Off the bat, I made clear that I am not a doctor, nor a pharmacist. I can’t offer advice, or guidance. But I can offer perspective, and context. So I shared a few things that I have learned about drugs - meaning prescription drugs - over the course of creating Drug Story.

Here’s my Top Three:

1. We want magic bullets. What we get is more messy.
   Most people have outsized expectations for the drugs they take. We want this new prescription to answer our prayers, to solve our problem. But reality is much more complicated: trial and error. Side effects. Tolerance. So many drugs - from antidepressants to GLP-1s to statins - create all sorts of consequences that many patients must muddle their way through. This is a constant concern.

2. Some drugs arrive in search of a disease.
   Pharmaceutical companies are incentivized to pursue profits - that incentive has created effective treatments for diseases that harm a great many people (heart disease, cancer treatments, HIV/AIDS, infectious diseases, etc). But sometimes chemicals affect the human body in ways that aren’t considered “treatments” for a “disease” - until there’s a new definition of a disease. Obesity. Insomnia. Anxiety. Low T. Male pattern baldness. It’s good to know when sometime new is happening, and when a game is being played.

3. Some drugs treat symptoms for much bigger problems.
   In diseases from diabetes to high cholesterol to respiratory diseases to mental health, drugs have save millions of lives. Yet there’s a difference between treating a disease and curing it - when I would define “cure” as tackling the root cause, and eliminating it. Many modern diseases are the inevitable result of the world we live in: our food, our entertainment, our communities. Drugs can do good. But if we want to solve big problems, we need to think bigger than drugs.

As I write now it is another Tuesday evening - the first Tuesday of the year that I have not dropped an episode of Drug Story.

Three months ago, back on Jan. 6, Drug Story had exactly 144 followers/listeners. I had little reason to expect that there would be much more of an audience than that. The whole idea of the podcast seemed very niche, as they say: one episode about one drug (but mostly about a disease). Who’d find that compelling?

I’m thrilled to say, plenty of people. A lot of people. Like a whole lot. Like 10X what I’d hoped for. (And I was greedy!)

Thanks to the help from a few generous friends with large audiences (thanks to Tim Ferriss and and Tim Harford), the show got a push out of the gate. And thanks also to the strange gods within Apple Podcasts, who deemed Drug Story worthy of featuring repeatedly: first as a New Show, then as a Featured Show, and ultimately as a Top Show.

Zoom! Tens of thousands of people now listen to every episode, every week. This idea - one drug, one disease, one episode - turns out to be a perfect way to tell larger stories about society and history and economics and medicine. About the world we live in, and how it got that way. These are amazing stories, and I am having a blast in telling them.

So if you haven’t heard: We are doing a Season 2 (and hopefully many more!). We have the same amazing team - helmed by the brilliant Rachel Swaby - and we are going to try to do TWICE the number of Drug Stories in this next batch. Adderall and ADHD. Insulin and diabetes. Humira and autoimmune disorders. Synthroid and thyroid conditions. And a whole mini-series on food supplements (iodine in salt, anyone?) that will make your head spin and your brain explode…at the same time!

Which brings me to three wishes:

1. Help us hit 1,000 reviews! Rate the show on Apple or Spotify
   In this age of algorithms, human inputs still matter so much! If you like what we are doing, please take 90 seconds and click through and write a review. Here’s a link to the show on Apple; here’s a Spotify link.

2. Spread the word! Send your friends a link with a thumbs-up emoji
   You may have binged Drug Story, but your besties have not. Spread your cred and turn them on to one of the top rated shows on Apple Podcasts! If we can get more listeners and followers while we make more episodes, we can all set Season Two up for success.

3. Support us! Subscribe or sponsor the show
   Drug Story is an independent effort - meaning nobody is paying our bills. So it really helps when people chip in to support the show here. Or even better: if you are part of a company that may be a worthy sponsor for Drug Story, send me a note at thomas@drugstory.co . We have a couple slots left, and it’s a really good deal to reach a really amazing audience.

The plan is to get Season Two live before end of 2026 - which will be an effort. Between now and then, I promise to drop monthly updates (at least!) on statin guidelines or Drug Story backstories or whatever else we come up with.

Thank you for being part of Drug Story - and for sticking with us in the weeks ahead.

.

So yeah. It’s a drug.

Fluoride used to be boring. 75% of US water is fluoridated, and it has greatly reduced the rate of tooth decay in this country and worldwide. Fluoridation has been among the biggest success stories in medical history.

But like a lot of medicine these days, fluoride is suddenly controversial. Again. Here and there, governments - the whole state of Utah, towns all over Florida - have removed fluoride from water. And predictably, the rate of tooth decay in children soars afterwards.

Still fluoride is also a riddle. Because while the US has had a lot of success with fluoride, most countries do NOT add it to their water - and many non-fluoridated countries have much the same rate of tooth decay as the US. Is fluoride toothpaste enough?

What is going on with fluoride?!

4 out of 5 dentists recommend you listen to this episode to the end!

This episode is all about ivermectin - which truly is a wonder drug! A veritable miracle cure.

For, ahem, river blindness. And for some other parasitic diseases, like hookworm. Mostly in animals.

But in the US, you have likely heard of ivermectin not as a treatment for parasites but for different purposes altogether. There are thousands of videos on YouTube and Instagram extolling ivermectin for viral diseases like Covid, various cancers, and for something called a “parasitic detox,” or a “parasitic cleanse.”

Really? This one drug does all that?

No. It does not.

In this episode of Drug Story, we tell the tale of ivermectin, and what gets all those people on TikTok raving about this drug - what they hope it could be, what they believe it works on.

And then, with an open mind, we go to the science – to tease apart the true miracles from the mere fantasies.

Things get a little crazy!

This show concerns Lydia Pinkham’s Vegetable Compound - one of the most popular patent medicines of the late 19th century. Mrs. Pinkham’s compound was sold as a “women’s tonic,” ideal for menopause or menstrual pain. The package promised big: “It cures bloating, headaches, nervous prostration, general debility, sleeplessness, depression, and indigestion.”

But did it, really? No, it did not. Lydia Pinkham’s compound was the epitome of a cure-all that cured nothing, a secret concoction of herbs and roots and other ambiguous ingredients that promised tremendous benefits without any evidence whatsoever.

Eventually, it was outrage over patent medicines like Mrs. Pinkham’s that turned into the creation of the FDA, and the evidence-based medicine we have today.

I’ll let Tim tell the whole story, but it’s a lovely episode.

We’ll be back next week with a new episode of Drug Story!

But here we are 20 years later, and much of that excitement has fizzled. Very few doctors are actually tailoring their treatments to individual patient DNA in the clinic.

In this episode I talk with , author of the new book Super Agers, about the promise of pharmacogenomics and the new frontiers of medicine. We talk about how he has always put science first - he shares the story of Vioxx, a pain reliever that he was early to see carried massive risks. Eric put his career on the line to let the world know about the problems.

It may have just been the electricity.

In this episode of Drug Story, we step into that sweet oblivion called sleep, and that infernal torment called insomnia. We visit hustle culture, where sleep is just an obstacle to crushing it.

And we learn about Ambien: the most popular sleeping pill ever invented. Until women started showing up in emergency rooms with amnesia...

Pain is probably the oldest problem in medicine. It’s the way our bodies tell us that something is wrong here.

But pain has long been considered a symptom. So when medicine can’t find what’s wrong, or when medicine can’t fix the pain, well, that’s usually the end of the story. And that’s left a lot of people with chronic pain suffering in silence.

In this episode, we learn why pain is one of the great mysteries of medicine - one of the most challenging conditions to diagnose, to measure, and to treat successfully.

We explore why the worthy effort to bring pain into the light inadvertently created what may be the most devastating social crisis (ahem, opioid epidemic) of the last century.

And we look at a new pain medicine - Journavx - which is not approved for chronic pain (yet) but has a lot of people hoping for a path to peace without addiction.

This is a place for the Drug Story audience to offer feedback on past epiosdes - AND ideas about what drugs we should cover in the future.

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But when the patent expires, other companies can manufacture and sell the drug, too. The drug goes “generic.” Typically that means lower prices for patients - more people benefit. That’s how the system is supposed to work.

That system relies a lot on good faith - and many pharma companies have gotten very good at finding ways to extend that 20 years, making small tweaks to a drug to extend their monopoly for years and years.

Today, I hand Drug Story over to the excellent journalist Dan Weissmann, host of the NPR podcast An Arm and A Leg. In this episode of An Arm and a Leg, Dan talks with John Green - author of the new book, Everything is Tuberculosis. Green explains how a very effective drug for TB was kept under patent protection for years, making it too expensive to treat millions of people with tuberculosis, leading to thousands of unnecessary deaths worldwide.

For men, this was partly about testosterone. After 40 or so, our bodies produce less and less testosterone, the hormone that helps give men energy and vigor and sex drive. Lower testosterone was just part of growing older.

But that was then! Nowadays, “Low T” is a bonafide medical condition - easily treated with a shot at your local neighborhood men’s health clinic.

Today, what used to be a secret sauce of bodybuilders or cheating athletes is now downright normal. Millions of men worldwide take testosterone therapy - and not just those over 40. Check out Reddit or TikTok...It is a WHOLE THING.

In this episode of Drug Story, we look at how TRT went mainstream, and how part of ordinary aging somehow became a disease.

That doubt and dread and worry?

That’s anxiety - and lucky for you, there’s a pill for that.

It’s called Xanax. And it works. Really well. And really fast.

Prescribed for panic attacks and anxiety, one dose of Xanax usually kicks in within 15 or 30 minutes. Just like that, you get a sense of calm and your concerns fall away. It’s not a high; more like the opposite. You feel relaxed, your brain stops racing. It does the trick.

Which is why Xanax is also super dangerous. Because of how well it works, and the way it works, Xanax is highly addictive. It brings such relief that one pill every once in a while turns into a little nibble every night. It tricks people into thinking that their concerns and worries can disappear with just one dose. Which is why Xanax is among the most counterfeited and abused drugs in the world right now.

In writing this episode, I started thinking that Xanax was a perfectly fine drug that is sometimes a problem. But as I dug in, I realized that Xanax, like all benzodiazepines, is a trickster. It promises to be an easy, even fun way to push our anxiety aside. But as much as it brings relief, it also brings consequences - which can turn deadly.

In this episode of Drug Story, we look at the idea of anxiety as a disease - a common human problem that can become, for some, a treatable condition. And we consider what “treatment” means, for good and for bad.

You could try a diet, though the diet companies were also in on the fix: For years, Weight Watchers was owned by Heinz … and Jenny Craig was owned by Nestle.

But it was up to you. You made your choices, and you had to live with them. And so the obesity rate in the US soared from around 15% of the population in 1970 to more than 40% today. Clearly something is going on other than free will and personal choices.

In this episode of Drug Story, we explore the origins of the obesity epidemic: the Green Revolution in agriculture, which saved a billion lives, but also made grain cheap cheap cheap. And we look at what happened when the tobacco companies decided to diversify into the food business (surprise: food became a lot more addictive, and a lot less healthy).

And we re-consider the whole idea of personal freedom and free will.

Our drug is Ozempic, and the whole class of GLP-1s that have up-ended our presumptions around obesity. These drugs have transformed millions of lives - they are surely one of the most impactful medical discoveries of the century.

Unfortunately, these drugs have not dispelled the stigma around obesity. They’ve just shifted it a bit. If you think taking a GLP-1 is “cheating,” you’re still stuck in the old blame game.

Even if you’ve read everything about GLP-1s, I think this will get you thinking in new ways about the disease business.

Still, depression is the most common mental health issue in the US and worldwide. Nearly 30% of Americans will be diagnosed with depression in their lifetimes.

Many people wind up taking an antidepressant. You’ve probably heard of these drugs by their brand names: Prozac Lexapro, Paxil and - the drug in this episode - Zoloft, known in generic form as sertraline, the most commonly prescribed antidepressant in the US today.

These drugs do help, but finding the right drug that works for the right person can take a lot of time, and a lot of trial and error. This can be a messy and frustrating process.

In this episode of Drug Story, we jump into that mess. We explore the mystery of how these drugs actually work - and why depression seems so much more common today than in the past.

Sources for this episode:

[1] History of depression through the ages (2020) Archives of Depression and Anxiety: From Hippocrates’ humoral theory to Freud, key historical figures shaped the understanding and treatment of depression.

[2] History of Depression (2015) The Oxford Handbook of Mood Disorders: Symptom-focused diagnosis and treatment have contributed to the medicalization of normal human sadness.

[3] Minnesota Multiphasic Personality Inventory (2023) StatPearls: Developed in the 1930s and published in 1942, the Minnesota Multiphasic Personality Inventory (MMPI) is the most common psychometric test for assessing personality traits and psychopathology including depression.

[4] The development of Minnesota Multiphasic Personality Inventory (1994) Journal of the History of the Behavioral Sciences: Two scientists at the University of Minnesota, Starke Hathaway and J. C. McKinley, developed the MMPI in the 1930s, a widely adopted survey measuring mental illness.

[5] Depression as a disease of modernity: Explanations for increasing prevalence (2012) Journal of Affective Disorders: Modern lifestyle factors like poor diet, inactivity, and social isolation may contribute to rising depression rates.

[6] The creation of the concept of an antidepressant: An historical analysis (2008) Social Science & Medicine: The term antidepressant gained traction in the 1950s-1960s, framing drugs as disease-specific treatments for depression.

[7] A RATING SCALE FOR DEPRESSION (1960) Journal of Neurology, Neurosurgery & Psychiatry: Max Hamilton published the Hamilton Rating Scale for Depression (HAM-D) questionnaire to measure severity of depression symptoms.

[8] The PHQ-9 (2001) Journal of General Internal Medicine: The Patient Health Questionnaire (PHQ-9) is a nine-item depression symptom questionnaire used to screen adults for depression. Kurt Kroenke developed the PHQ in the mid-1990s with funding from Pfizer.

[9] The Origin Story of the Zoloft Sad Blob, a Clinically Depressed Icon (2021) Mel Magazine: Early 2000s ads used a blob character to represent depression, which drew both praise and criticism.

[10] Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature (2005) PLoS Medicine: SSRIs are marketed as correcting a serotonin deficiency, despite a lack of conclusive scientific evidence.

[11] Antidepressants Don’t Work the Way Many People Think (2022) The New York Times: Experts note that the chemical imbalance theory of depression is outdated.

[12] Development of the commercial process for Zoloft®/sertraline (2005) Chirality: Continuous chromatography enabled efficient large-scale production of sertraline.

[13] The Architect of Zoloft (2015) Reed Magazine: Kenneth Koe modified tametraline compounds to block serotonin reuptake, leading to sertraline hydrochloride’s release as Zoloft in 1992.

[14] ACS Award for Team Innovation (2006) Chemical & Engineering News: Zoloft’s discovery was led by Pfizer scientists Reinhard Sarges, B. Kenneth Koe, Willard M. Welch, Albert Weissman, and Charles A. Harbert.

[15] Sertraline versus other antidepressive agents for depression (2010) Cochrane Database of Systematic Reviews: Sertraline is a selective serotonin reuptake inhibitor (SSRI) used as a first-line treatment for major depression, with evidence demonstrating superior efficacy over other antidepressants.

[16] Do Antidepressants Work? (2018) The New York Times: In multiple meta-analyses of antidepressant trials, researchers confirm that while antidepressants are more effective than placebos for treating acute major depression, the actual clinical benefits are mostly modest. Study design, participant selection, and publication bias may result in more favorable evidence supporting the use of antidepressants.

[17] What Obesity Drugs and Antidepressants Have in Common (2023) The New York Times: Aaron Carroll writes that because science cannot fully explain the biological mechanisms of mental health and obesity drugs, these treatments are stigmatized and incorrectly viewed as a lack of willpower rather than medically necessary.

[18] The STAR*D study: treating depression in the real world (2008) Cleveland Clinic Journal of Medicine: The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial established that 70% of patients with clinical depression could achieve remission using antidepressants after following a four-step sequence of switching various treatments until they found relief.

[19] The STAR*D Trial: It Is Time to Reexamine the Clinical Beliefs That Guide the Treatment of Major Depression (2015) The Canadian Journal of Psychiatry: A reexamination of The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial argues the original findings from the study were overestimated due to poor study design and bias.

[20] Restoring STAR*D: A Reanalysis of Drug-Switch Therapy After Failed SSRI Treatment Using Patient-Level Data with Fidelity to the Original STAR*D Research Protocol (2025) medRxiv: A reanalysis of the STAR*D data found that switching antidepressants provides minimal benefit and has a higher risk-to-benefit ratio than stated in the original trial.

[21] Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials? (2008) Philosophy, Ethics, and Humanities in Medicine: An analysis of antidepressant data submitted to the FDA reveals selective reporting and publication bias that mask negative results, leading to an inflated perception of drug benefits.

[22] Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts (2019) American Psychological Association: Evidence-based recommendations for treating depressive disorders in children, adults, and older adults.

[23] Predictive biomarkers could ease the exhaustive trial-and-error of antidepressants (2023) STAT: Research aims to identify biomarkers to reduce the trial-and-error of antidepressant prescribing.

[24] AI Tool Matches Patients to Effective Antidepressants Faster (2024) Neuroscience News.com: Platforms like MeAgainMeds.com aim to reduce trial-and-error in finding effective antidepressants.

[25] More treatment but no less depression: The treatment-prevalence paradox (2022) Clinical Psychology Review: Despite advances in treatment, depression prevalence has not decreased since the 1980s.

[26] How Sertraline (Zoloft) Completely Changed My Life (2024) @itsblakematthew: Blake Matthews details his experience with Zoloft.

Once you turn 40, it seems like half the people you know are taking a statin drug. You know, because their cholesterol is high, and to prevent heart disease down the line. It makes sense: better safe than sorry.

This is a huge triumph for preventive medicine. Statin drugs have saved (or improved) the lives of millions of people because they acted early. This is how medicine (and public health) is supposed to work.

But the devil is in the details. Like all drugs, statins have side effects. And when they are prescribed for many millions of people, the math means that millions of people will not, in fact, get any benefit from the drug. It turns out that atorvastatin (and other statin drugs) may be the most over-prescribed drugs in the history of medicine. And therein lies a Drug Story.

SOURCES FOR THIS EPISODE

[1] Akira Endo- Gairdner Gala Acceptance Speech (2017) Canada Gairdner Awards: Akira Endo, the Japanese biochemist who discovered the first statin, reflects on American dietary and lifestyle habits that inspired him to develop a solution to prevent heart disease.

[2] Influence of nicotinic acid on serum cholesterol in man (1955) Archives of Biochemistry and Biophysics: Since 1955, the B-vitamin niacin (nicotinic acid) has been used in the treatment of high cholesterol.

[3] Atherosclerotic Cardiovascular Disease Risk Estimates Using the Predicting Risk of Cardiovascular Disease Events Equations (2024) JAMA Internal Medicine: The Predicting Risk of Cardiovascular Disease Events (PREVENT) cardiovascular risk equation excludes race, adds kidney function and statin use, and suggests fewer adults may be eligible for statins compared to pooled cohort equations.

[4] It Took A Brilliant Marketing Campaign To Create The Best-Selling Drug Of All Time (2011) Business Insider: Lipitor became the best-selling drug of all time through aggressive marketing to doctors and coinciding with the FDA’s allowance of direct-to-consumer drug advertising in 1997.

[5] Learning From Our Parents’ Heart Health Mistakes (2017) The New York Times: Indigenous South Americans, the Tsimane, have low rates of coronary artery disease and healthier lifestyles compared to Americans, offering a model for prevention.

[6] CHOLESTEROL: DRUG HAILED AS TREATMENT BREAKTHROUGH (1987) The New York Times: The New York Times introduces lovastatin, a novel drug predicted to revolutionize the treatment of high cholesterol.

[7] Millions fewer people may need statins, a new study suggests. But guidelines have yet to agree (2024) STAT: The number of adults recommended for statins could drop from 45.4 million to 28.3 million based on new risk calculations.

[8] A historical perspective on the discovery of statins (2010) Proceedings of the Japan Academy: Akira Endo’s discovery of compactin from fungal cultures led to lovastatin, the first commercial statin.

[9] The Role of Lipids and Lipoproteins in Atherosclerosis (1950) Science: John Gofman discovered LDL cholesterol and its correlation with atherosclerosis through ultracentrifugation of plasma lipoproteins.

[10] Statins for Primary Cardiovascular Disease Prevention: Time to Curb Our Enthusiasm (2022) JAMA Internal Medicine: Cardiologists question the benefit of statins for individuals with low cardiovascular disease risk, citing limited evidence.

[11] History of the Framingham Heart Study (1957) Framingham Heart Study: The Framingham Heart Study identified key cardiovascular risk factors, including high cholesterol, blood pressure, smoking, obesity, diabetes, and inactivity.

[12] “For Me There Is No Substitute”: Authenticity, Uniqueness, and the Lessons of Lipitor (2010) American Medical Association Journal of Ethics: Lipitor backlash followed when it was revealed that Dr. Robert Jarvik, spokesperson in Lipitor ads, was not licensed to practice medicine and misrepresented his credentials.

[13] Lipitor a story of rags to riches (2011) Arkansas Democrat-Gazette: Lipitor achieved success by lowering LDL cholesterol more effectively than competitors, aided by expanded statin eligibility guidelines.

[14] History in medicine: the story of cholesterol, lipids and cardiology (2021) e-Journal of Cardiology Practice: Cardiology research has an extensive history: from its identification in gallstones in 1769 to Nobel Prize-winning discoveries on lipids and atherosclerosis.

[15] Discovery of Lipitor (2009) Triumph of the Heart: The Story of Statins: Despite being the fifth statin introduced, Lipitor dominated the market due to superior LDL-lowering efficacy.

[16] Counting Cholesterol (1987) The MacNeil/Lehrer NewsHour: Merck’s Mevacor became the first FDA-approved statin and cholesterol-lowering drug.

[17] Cardiovascular Disease Resulting From a Diet and Lifestyle at Odds With Our Paleolithic Genome: How to Become a 21st-Century Hunter-Gatherer (2004) Mayo Clinic Proceedings: High cholesterol may stem from a mismatch between modern diets and Paleolithic human biology.

[18] What Will the New Cardiovascular Risk Calculator Mean for Patients? (2024) Harvard Medical School: The Predicting Risk of Cardiovascular Disease Events (PREVENT) model could significantly reduce the number of statin-eligible adults.

[19] Pfizer Gets Its Deal to Buy Warner-Lambert for $90.2 Billion (2000) The New York Times: Pfizer purchased Lipitor’s manufacturer for $90.2 billion.

[20] Pharmaceutical Mycelia: A story of statins LGC Standards: Early statins derived from Penicillium and Aspergillus inhibit HMG-CoA reductase to lower cholesterol.

[21] A New Women’s Issue: Statins (2014) The New York Times Well Blog: Cardiologists raise concerns over limited evidence for statin benefits in women due to underrepresentation in trials.

[22] Statins for Primary Prevention: The Debate Is Intense, but the Data Are Weak (2016) JAMA: Researchers highlight inflated benefits of statins and incomplete adverse event data.

[23] Medical Marketing in the United States, 1997-2016 (2019) JAMA: U.S. medical marketing expenditures rose from $17.7B in 1997 to $29.9B in 2016, with limited regulation of misleading ads.

[24] Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy: part I (2004) Journal of Lipid Research: Nikolai Anitschkow induced vascular lesions in rabbits by feeding them cholesterol, resembling human atherosclerosis.

[25] Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy: part II: the early evidence linking hypercholesterolemia to coronary disease in humans (2005) Journal of Lipid Research: Research supported lowering cholesterol through dietary changes; confirmed in the Framingham Heart Study.

[26] Primary nonadherence to statin medications: Survey of patient perspectives (2021) Preventive Medicine Reports: In this study, over half of the patients prescribed statins but not taking them never informed their prescribers, often preferring lifestyle changes or natural remedies.

The story of Epipen is also a story of unintended consequences and unexpected discoveries, one that goes from the Azores, some islands in the middle of the Atlantic Ocean, to Sweden, the home of the Nobel Prize, to Vietnam, during the Vietnam War.

This story also lands very close to home. Today, Epipens are in schools, they’re in malls, they’re on airplanes, they may even be in your backpack or purse or glove compartment - just in case. So in this episode, we’ll learn all about that.

And there’s also the biggest unintended consequence of all. It turns out that for many of the millions of people like Alex who live with food allergies - and the risk of anaphylaxis - their condition may in fact be the result of one of the biggest blunders of the past century of medicine and public health.

Sources for this episode

[1] A Mighty Pen (2013) Science History Institute Museum and Library: In the 1970s, inventor Sheldon Kaplan developed an epinephrine autoinjector in response to the need for rapid, self-administered injections to treat anaphylactic shock.

[2] Auvi-Q Versus EpiPen: Preferences of Adults, Caregivers, and Children (2013) The Journal of Allergy and Clinical Immunology: This study evaluates preference for the Auvi-Q epinephrine autoinjector over the EpiPen among adults, caregivers, and children.

[3] Epinephrine Administered in Anaphylaxis: The Evolution of 0.3 mg Dosage (2023) Therapeutic Advances in Allergy and Rhinology: Anaphylaxis was first formally discovered by French scientists Charles Richet and Paul Portier in experiments with dogs. They found that dogs became more sensitive, rather than less sensitive, to a toxin after an initial small dose.

[4] Northeastern alumnus the genius behind life-saving EpiPen (2016) Northeastern Global News: Sheldon Kaplan reengineered a Cold War-era device, the ComboPen, that delivered a nerve agent antidote, into a device that delivered epinephrine. The new device, EpiPen, was patented under Kaplan’s name in 1977.

[5] Body and Mind; Backward Protection (1989) New York Magazine: Anaphylaxis is a biological mechanism where the immune system provides misguided “backwards protection” by overreacting to allergens such as nuts, penicillin, or insect stings.

[6] The Use of Adrenal Substance In the Treatment of Asthma (1900) Journal of the American Medical Association: Early research by Dr. Solomon Solis-Cohen showed that using extracts from animal adrenal glands could significantly relieve asthma symptoms by strengthening blood vessels and reducing swelling in the airways.

[7] The Allergy Epidemics: 1870–2010 (2015) The Journal of Allergy and Clinical Immunology: The rise in allergies over the past 150 years can be attributed to advances in hygiene and lifestyle changes, such as increased sedentary indoor lifestyles.

[8] History of food allergy and where we are today (2024) World Allergy Organization Journal: Once poorly understood, food allergies are now managed through strategies beyond avoidance, including immunotherapy, biologic treatments, and early allergen introduction for prevention.

[9] How Marketing Turned the EpiPen Into a 20 Billion-Dollar Business (2015) Bloomberg Businessweek: Mylan Pharmaceuticals, the manufacturer of EpiPen, ran marketing campaigns emphasizing the dangers of food allergies and lobbied lawmakers to place EpiPens in schools and public venues. As a result, the EpiPen became a $1 billion-per-year product, and its price increased by 400% after Mylan acquired it in 2007.

[10] Epinephrine: a short history (2015) The Lancet Respiratory Medicine: In 1894, the English physician George Oliver and the English physiologist Edward Schafer discovered the physiological effects of adrenal medulla extract. In 1899, American biochemist John Jacob Abel successfully purified the extract’s active ingredient and named it epinephrine. It was then synthesized in ampules by Parke-Davis & Company in 1909.

[11] The ancestry of allergy: Being an account of the original experimental induction of hypersensitivity recognizing the contribution of Paul Portier (1985) The Journal of Allergy and Clinical Immunology: In 1902, Paul Portier and Charles Richet discovered anaphylaxis after observing that a second, weak injection of sea anemone toxin caused fatal hypersensitivity in dogs rather than the expected immunity.

[12] Feed Your Kids Peanuts, Early and Often, New Guidelines Urge (2017) The New York Times: The National Institute of Allergy and Infectious Diseases shifted its approach to child nutrition in 2017 by recommending that parents introduce peanut-based foods to infants as early as four to six months of age.

[13] Portier, Richet, and the discovery of anaphylaxis: A centennial (2002) The Journal of Allergy and Clinical Immunology: Paul Portier and Charles Richet discovered anaphylaxis while investigating the toxins of marine life aboard the yacht of Prince Albert of Monaco in 1901.

[14] The Prevalence of Chronic Respiratory Disease in the Industrial Era The United States, 1895–1910 (2003) National Bureau of Economic Research: Chronic respiratory disease prevalence rose in the United States between 1895 and 1910 due to rapid urbanization, industrial pollution, and the emergence of cigarettes.

[15] Shock Reaction Following Ingestion of Mango (1965) Journal of the American Medical Association: A case study on an anaphylactic-like response to mango helped establish early clinical understanding of food-induced anaphylaxis.

[16] Slow Epinephrine In the Treatment of Chronic Asthma (1939) The Journal of Allergy: This 1938 study shows that mixing epinephrine with peanut oil allows the body to absorb the medicine more slowly than the standard water-based version. By delaying absorption, patients can reduce the frequency of injections.

But they never really fix the problem, do they? Yes, drugs can help people manage their disease. They treat the symptoms. But they rarely remedy what caused the disease in the first place. And therein lies a story. Launching Jan. 6, 2026.