William Avery Rockefeller Sr. was alleged to have been a charming scoundrel. He convinced two intelligent women to marry him but did not bother to divorce his first wife before marrying his second wife. He had no medical training but claimed to be a “botanic physician” and sold homeopathic elixirs under his ‘stage name’ of Dr. William Levingston. For a mere $25, he provided the severely ill and profoundly gullible with concoctions formulated to cure cancer, as well as innumerable other ailments. He was only one of a virtual army of con artists in the nineteenth century who profited from the absence of safe and effective medications. All that distinguished him, aside from his being a bigamist, from the many itinerant ‘snake oil’ salesmen of his era were his children: William Avery Rockefeller Junior and John Davison Rockefeller Senior, both titans of American capitalism.
Although William Sr., also affectionately referred to as “Devil Bill,” had no skills as an herbalist, his relatively good health and longevity convinced his multimillionaire son, John D. Senior, to rely upon homeopathic medications throughout his life. Both William Sr. and John Sr. survived into their nineties and were quite active well into their ninth decade. In healthcare, as in business, John D. was flexible, innovative, and generous. Despite his reliance on homeopathic approaches, he provided funding for numerous medical schools that dismissed homeopathy as unscientific and ineffective.
Homeopathic physicians were numerous in the 19th century and were still being licensed to practice medicine in the 20th century. They subscribed to managing some diseases using minimal doses of agents that elicited symptoms similar to those being experienced by the patient. A person with a high fever would be given a small dose of an agent that routinely caused a fever. Some would argue that our development of vaccines was prompted by homeopathic logic. Homeopathic treatments for unexplained symptoms are still popular in some parts of the U.S. and Europe. Giving an antagonistic agent, such as a fever-lowering agent in the face of a high fever, was and is still referred to as allopathic medicine. Aspirin and antibiotics are medications developed with allopathy in mind.
The homeopathic hucksters of the nineteenth century were successful because trained physicians and pharmacists were relatively scarce and infrequently provided better outcomes than the flim-flam men in treating diseases. Rational drug development based on scientific principles and clinical trials gained traction in the 20th century, but even in the 21st century, physicians are routinely confronted by patients taking ‘potent elixirs’ from ambiguous sources for complaints conventional medicines failed to relieve. Drug development, both conventional and illicit, has become a hugely profitable business, well beyond Devil Bill’s or his son’s expectations, but false, unsubstantiated, or misleading claims are still widespread.
One of the more fortuitous discoveries during the past decade has been the observation of weight loss with the diabetes drug semaglutide. This is sold as an injectable medication under the brand names Ozempic and Wegovy. This unexpected benefit of the glucose-lowering drug is well-established, but a potentially more important side effect of the drug has recently surfaced. This drug seems to reduce alcohol and narcotic cravings. There are, in fact, animal studies that support the anecdotal reports from people that these drugs blunt the drive to drink alcoholic beverages. Less numerous accounts suggest a beneficial effect in managing opiate addiction.
Experience with semaglutide indicates that it can be used for years without producing any permanent damage, at least in people being treated for diabetes mellitus. The cost of either Ozempic or Wegovy is high, but insurance companies may cover the cost for people taking the drug for diabetes, rather than for weight management or chronic alcoholism. Lower costing, generic equivalents are probably more than a decade away.
If the benefits of semaglutide are proven to include weight and addiction management, this drug could revolutionize several areas of medical practice. Unfortunately, prior claims of similar benefits with other drugs have proven overblown. When methadone was first introduced to help narcotic addicts get off and stay off opiates, there was considerable optimism that the “war on drugs” might be won. Methadone helped some people with narcotic addictions, but its impact was limited and the “war” continued, a war which by any measure we have lost. Decades before the advent of methadone, many physicians hailed cocaine as a ‘safe and effective’ treatment for opium addiction. It was not and is not.
Agents to suppress alcohol addiction have been equally disappointing. More than sixty years ago, a drug called disulfiram, originally sold under the brand name Antabuse, was introduced to manage chronic alcoholism. It reduced alcohol consumption by inducing nausea and vomiting when the patient on the medication drank alcoholic beverages. It required longterm, consistent adoption by the person with chronic alcoholism to achieve detoxification. It also required continued drug use to avoid a relapse. Withdrawal from alcohol is as unpleasant as the effects of alcohol consumption while on disulfiram. Consequently, most people with chronic alcoholism opted to omit the drug and drink the booze.
Nonetheless, that there may be a ‘noninvasive’ way to help people with chronic alcoholism reduce or eliminate their alcohol cravings is encouraging. The organ damage and social costs of alcohol abuse are familiar to most Americans, and if the benefits of semaglutide are confirmed, programs to encourage use of this drug will be developed and financed. This assumes that Americans will stop relying on alcoholic beverages to ‘drown’ their sorrows, suppress their inhibitions, or celebrate landmark events. This is a rather grandiose assumption.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the U.S., as well as in England, Germany, and France.
