u/pillar_drug_club

▲ 26 r/gout

The Man Who Screened 350 Molecules

If you have gout, there is a reasonable chance you have been handed a prescription for indomethacin. Your doctor called it a strong NSAID, told you to take it with food, warned you about your stomach. What they almost certainly did not tell you is who made it, or what that person’s life looked like. I am a pharmacist. I dispense it regularly. Until recently I had no idea who made it either.

Tsung-Ying Shen was born in China in 1924 to a family that understood what it meant to build things under difficult conditions. His father, Tsu Way Shen, had gone to the University of Michigan in 1910 on a government scholarship, one of the first waves of Chinese students sent abroad to learn western engineering and bring it home. He returned to China, built infrastructure across provinces, rose to vice president of the Conservancy Engineering College in Nanjing, and died in 1932 doing a bridge inspection in a rural area. Tsung-Ying was eight years old.

His mother, a widow at thirty-six with five children, raised the family through the Japanese invasion, through World War II, through the years that killed one of her sons, a military airman. The other four all earned doctoral degrees in the United States. That is the family Tsung-Ying came from.

In 1946 he graduated from National Central University, won a national scholarship, and left a country sliding toward civil war to study organic chemistry in England. PhD from Manchester in 1950, postdoctoral work at Ohio State and then MIT, where he met Amy Lin, a physical chemist whose own research data would contribute to the Scatchard Equation, a foundational tool in receptor pharmacology still used in drug development today. In 1956, they moved to Rahway, New Jersey. Shen joined Merck.

The pharmaceutical industry in the late 1950s was chasing a specific problem. Cortisone had arrived in 1949 as a miracle treatment for rheumatoid arthritis and spent the next decade revealing its costs: osteoporosis, adrenal suppression, psychiatric effects. By 1962 the Cortisone Era was declared over, and every major drug company was looking for something that fought inflammation without destroying the body. The term NSAID did not yet exist. They were looking for something they did not have a name for.

Shen screened approximately 350 indole derivatives for anti-inflammatory activity. Three hundred and forty-nine did nothing. One did. He called it indomethacin. FDA-approved in 1965, it was the first drug announced under the new term “non-steroidal anti-inflammatory agent.” It did not just fill the vacuum cortisone had left. It named the category.

For gout specifically, indomethacin was a significant development. Acute gout flares involve uric acid crystals triggering an immune response so aggressive that the joint becomes untouchable within hours. Indomethacin’s potency made it particularly suited to that kind of inflammatory cascade, working faster and harder than the alternatives. It remains a first-line option today. The warnings on your prescription bottle trace directly back to what clinicians learned in the years after 1965: take it short-term, protect your stomach, know your kidney function.

In 1976, something unexpected happened. Two independent research groups published back-to-back papers in the New England Journal of Medicine reporting that indomethacin could pharmacologically close patent ductus arteriosus, a heart defect in premature infants that had previously required surgery on babies sometimes weighing under a kilogram. Prostaglandins were keeping the vessel open. Indomethacin blocked prostaglandin synthesis. The vessel closed. Nobody at Merck in 1956 had designed a drug for premature infant hearts. It became standard neonatal care for nearly three decades anyway.

That same year Shen used a Merck research award to establish a visiting lectureship at MIT. The inaugural speaker was Bengt Samuelsson, who would later win the Nobel Prize for his work on prostaglandins, the exact mechanism explaining why Shen’s molecule was saving premature infants. Shen did not win the Nobel. Samuelsson did, for explaining what Shen’s molecule had been doing for twenty years.

Shen retired from Merck in 1986, became a professor at the University of Virginia, and continued research until 2001. In 2012 he established a fellowship at MIT in his wife’s name, supporting female graduate students in physical chemistry. He died September 1, 2024, in Greenbrae, California. He was ninety-nine.

If you have gout, the molecule he built from 350 failed attempts is probably in your medicine cabinet. It was prescribed over 500,000 times in the United States last year. Some molecules outlast the people who made them. This one already has.

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u/pillar_drug_club — 15 hours ago
▲ 270 r/Hashimotos+1 crossposts

The most prescribed drug in America has a wilder origin story than basically anything else on the shelf. A physician in 1891 treated a woman with sheep thyroid injections. She lived 28 more years and consumed the glands of 870 sheep. That’s the beginning.

I’m a pharmacist. I dispense levothyroxine probably 40 times a day. I knew almost nothing about where it came from until I went down the rabbit hole.
The short version:
A surgeon named William Gull described a condition in 1873 where women became slow, puffy, cold all the time, mentally foggy. Nobody knew what it was. The thyroid gland was considered possibly vestigial. A committee gathered 61 cases and 18 autopsies and named the condition myxedema. They had no treatment.
A physician named George Murray decided in 1891 that if the thyroid does something essential and these patients have no thyroid function, maybe you just give them someone else’s. He injected sheep thyroid extract into a 46-year-old woman who had been severely symptomatic for years. She dramatically improved. He published it in the BMJ. His original patient lived another 28 years on sheep thyroid preparations and died at 74 in 1919. Murray later calculated she had consumed the glands of approximately 870 sheep.
Then a chemist at the Mayo Clinic named Edward Kendall processed 6,500 pounds of hog thyroid glands over Christmas 1914, fell asleep in the lab, and woke up to crystals in a beaker. That was the first isolation of thyroxine. He later won the Nobel Prize. Not for thyroxine. For cortisone. The thyroid work is a footnote in his prize biography.
Then two chemists in London figured out the structure and synthesized it from scratch in 1927. Then a biochemist named Rosalind Pitt-Rivers and a Canadian postdoc named Jack Gross identified that thyroxine isn’t even the active hormone - it converts to something else in your body, which they published in The Lancet in 1952. Pitt-Rivers got elected to the Royal Society. The discovery got increasingly attributed to Gross in the literature over the following decades.
Then in 1987 the manufacturer of Synthroid paid a UCSF researcher to study whether their drug was better than generics. She spent five years on it. In 1990 she had the answer: no difference. They spent the next seven years trying to prevent her from publishing it. The Wall Street Journal ran it on the front page in 1996. JAMA published the study in 1997. The company eventually paid $135 million to settle a consumer class action and another $41.8 million to 37 states.
The FDA’s current regulatory framework for levothyroxine descends directly from the aftermath of that suppression.
150 million prescriptions a year. I wrote up the full history as a long read for anyone interested.

https://pillardrugclub.com/blog/the-molecule-that-replaced-an-organ

u/pillar_drug_club — 1 day ago
▲ 280 r/gout+1 crossposts

The drug most of you are taking is 3,500 years old. The Egyptians figured it out before writing was widespread. Nobody knew why it worked until 1970.

I’m a pharmacist. I’ve dispensed colchicine hundreds of times. A few months ago I started actually researching the history of the drugs I dispense and colchicine stopped me cold.
The Ebers Papyrus, an Egyptian medical text from around 1550 BC, documents autumn crocus as a treatment for swollen joints. That manuscript was already copying older documents when it was written. We don’t know how much older.
Egyptian physicians knew three things about it: too little did nothing, the right amount reduced the swelling, and too much killed the patient. They figured out the correct dose the only way available to them. Some patients did not survive the figuring out.
Here is the part that got me. Nobody knew how colchicine actually worked until the 1970s. Not the Egyptians, not the Greeks, not the medieval Arab physicians who wrote detailed preparation guides for it, not the French chemists who isolated the molecule in 1820. Physicians prescribed it correctly for three thousand years based entirely on observation. No mechanism. No theory. Just the repeated confirmation that it worked and the repeated warning not to use too much.
The mechanism, when it was finally described, turned out to be strange. Colchicine doesn’t fight inflammation the way most drugs do. It binds to a structural protein inside your cells called tubulin and prevents it from forming the fibers cells use to move around. In gout specifically, it stops the white blood cells that rush to uric acid crystals in your joints from getting there. No migration, no inflammatory cascade, no pain.
That’s the same mechanism that makes it toxic in overdose, by the way. It’s not selective. At the right dose it disrupts neutrophil migration. At too high a dose it disrupts cell division everywhere, and the GI tract goes first. There is no antidote. The Egyptians understood the margin mattered 3,500 years before anyone could explain why.
The plant it comes from, Colchicum autumnale, is named after Colchis. The ancient Black Sea kingdom. The homeland of Medea. Greek mythology specifically assigned the plant’s poison properties to her, which means the Greeks understood its toxicity well enough to write it into their stories.
It flowers every autumn without any leaves, which is why botanists eventually named it naked ladies. The flowers appear alone from bare ground, months after the leaves have died back. For centuries people thought it was two different plants.
Anyway. I found it remarkable that something this old still works, that the mechanism took this long to understand, and that the correct dose was calibrated through observation across dozens of civilizations who couldn’t communicate with each other and all arrived at roughly the same answer.
If you’re on colchicine and have questions about how it works or how it interacts with other things you’re taking, happy to answer in the comments.

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u/pillar_drug_club — 3 days ago

Frustrated with how inconsistent GoodRx prices are for my patient’s BP meds, so I put together a simple calculator that shows what common generics cost at direct pricing vs retail. No signup required, just plug in your drugs.

https://pillardrugclub.com

Curious what numbers people are getting — especially for metformin, lisinopril, atorvastatin combos.

reddit.com
u/pillar_drug_club — 17 days ago

Frustrated with how inconsistent GoodRx prices are for my patient’s meds, so I put together a simple calculator that shows what common generics cost at direct pricing vs retail. No signup required, just plug in your drugs.

https://pillardrugclub.com

Curious what numbers people are getting — especially for metformin, lisinopril, atorvastatin combos.

reddit.com
u/pillar_drug_club — 17 days ago

Frustrated with how inconsistent GoodRx prices are for my patient’s meds, so I put together a simple calculator that shows what common generics cost at direct pricing vs retail. No signup required, just plug in your drugs.

http://pillardrugclub.com

Curious what numbers people are getting — especially for metformin, lisinopril, atorvastatin combos.

reddit.com
u/pillar_drug_club — 17 days ago