I’ve always been intrigued by glandular therapies, in which dried animal endocrine gland is used to treat a variety of medical conditions. And while I appreciate their medical benefits (like everything, some work better than others), even more interesting is their role in the history of medicine over the past century.
Just when I thought everyone had forgotten about glandulars except a few doctors writing prescriptions for Armour thyroid (made from dried pig thyroid) and naturopaths, who use glandulars regularly, up pops an article–in the New York Times business section no less–on glandular therapy.
Once the whipping boy of conventional medicine, glandulars are back, now basking in the golden glow of serious money.
A history marred by goat testicles…
Glandular therapy was first taken seriously by physicians in the 19th century, when it was discovered that dried porcine thyroid gland could treat underactive thyroid and dried animal-based adrenal glands could treat Addison’s disease. Before this, neither condition was controllable.
As the years passed, doctors tried other glands with varying rates of success: ovaries for infertility and menopause, testicles for faltering male sex drive, thymus for the immune system, and pancreas for digestion. Later, research moved well beyond glands. Concentrated spleen was tried for anemia, heart for cardiac diseases, lung for pulmonary conditions–even brain for Alzheimer’s. To give you an idea of how seriously medicine took glandular therapies, the 1925 textbook Medical Glandular Therapy was published as a joint project between the AMA and the University of Chicago, edited by Frank Billings, MD, for whom a U of C hospital was later named.
Historically, glandular therapy has been rife with extremes. At one end we have Mayo Clinic rheumatologist Philip S. Hench, MD, who after decades of research was awarded a Nobel Prize for his work with adrenal and pituitary hormones (again, extracted from animals). At the other extreme is medical history’s most notorious charlatan, John R. Brinkley, and please do click to read more about this provocative man. During some of the same years Dr Hench was researching glandulars, Brinkley owned an empire of clinics and hospitals (as well as, oddly, radio stations), literally getting away with murder by implanting goat testicles into the scrotums of old men seeking eternal youth and into women seeking fertility.
There’s a logic to legitimate glandular therapy: that the gland or organ of a mammal that is structurally close to its human version would contain all the micronutrients needed to bolster proper function in people. A few highlights:
- The most widely used glandular today is Armour thyroid (remember, Armour was originally a Chicago meatpacking company).
- Before cortisone was synthesized, animal-based adrenal glands were also harvested for their hormone content.
- The prescription drug Premarin is indirectly a glandular. A pregnant mare’s urine, estrogen-enriched by her ovaries, is collected, dehydrated, and used by millions of women for menopause symptoms.
- Having been raised in a drugstore, I remember prescriptions written for pancreas extract as a digestive aid and liver extract as a treatment for anemia.
The death knell of glandular therapy was, not surprisingly, the pharmaceutical industry. Beginning in the 1940s, chemists had synthesized hormone molecules that they claimed worked better than those harvested from animals. Conventional physicians were sold on this. To use Synthroid (synthetic thyroid) instead of Armour seemed to indicate you were more progressive and up-to-date. Prednisone replaced adrenal cortex extracts and synthetic testosterone skin cream was definitely gentler than “Doc” Brinkley’s surgery.
…And now by greed
But now a particular glandular is back in the news, and here’s an interesting side note. Maybe because this story is in the business section of the New York Times, and not the science section, no one seems particularly angry at the gist of the story. The fact that we’re supposed to accept this as business as usual tells us a lot about ourselves.
Quick background: the Nobel prize winner Dr. Hench, mentioned above, extracted a hormone from the pituitary gland that was capable of stimulating the adrenal gland to release cortisol. He named it adrenocorticotropic (adrenal-stimulating) hormone, or ACTH for short.
Early in my training, ACTH injections were helpful when you needed to give a patient a short course of corticosteroid drugs, such as for asthma, rheumatoid arthritis, or a flare-up of multiple sclerosis. ACTH is also used to test whether the adrenal glands are working or not (inject ACTH, wait a few hours, measure blood levels of cortisol). When I first opened my office and bought an assortment of medications for injections, I purchased a couple of bottles of ACTH for about $20. It worked great for bad cases of poison ivy—one injection raised blood levels of cortisol enough to cool widespread inflammation.
According to the NYT piece, the original pharmaceutical company that produced ACTH never made much money on it, so the drug languished and then disappeared. In the late 1990s, ACTH was discovered to be the best treatment for a rare childhood disorder called infantile spasms, but there weren’t enough patients to make it financially worthwhile to produce the drug. Then, in 2001 the small company Questcor bought the rights to the drug for a paltry $100,000, soon recognizing they had a potential gold mine in a drug that could save children’s lives as well as potentially treat other conditions. And so, figuring that health insurance companies had deep pockets beyond anyone’s wildest dreams, they jacked up the price.
Are you ready for this? Move your coffee, please. You don’t want an accident. ACTH is now $28,000 (twenty eight thousand dollars!) per vial. This is not a misprint. A vial contains 5 milliliters, or exactly one teaspoonful.
This pricing shot Questcor’s share price from 60 cents to $50 and allowed it to hire a bevy of salespeople, who promoted the product for conditions ACTH hadn’t been proven to help, and which were treatable by vastly cheaper drugs. By the way, the stock fell to $25 when insurers refused to pay for ACTH for any condition except infantile spasms.
And there’s your update on glandulars. From implanting goat testicles to saving the lives of children whose parents are lucky enough to have health insurance to gouging our healthcare system to the max. At the heart of the NYT article in which Questcor’s CEO justifies the price of ACTH–saying he can’t lower it because his shareholders would sue–is the spirit of Wall Street’s arch-villain Gordon Gekko: “Greed is good” (and, in this case, legal).
David Edelberg, MD
PS: Following up on last week’s post, I learned more about the approach the Illinois Division of Professional Regulation is taking to shut down colon therapists. They’ve ruled that giving an enema is a surgical procedure (only the Illinois State Medical Society could come up with this) and therefore colon irrigation is practicing medicine without a license. I’d bet there’s no single MD in the entire nation who actually offers colonics, and thus you’re watching conventional medicine in real time attempting to drive an alternative therapy into extinction.
Next week: How to use glandular therapies for common health problems