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Which Five Drugs Would You Take On A Remote Desert Island?

This post follows a lengthy conversation I had with my wife, a physician-scientist, about this very topic.

Many of you who attended the ScienceOnline2010 conference here last January probably met Carmen Drahl, the Princeton-trained chemist who now writes for Chemical & Engineering News and their appropriately-named drug discovery blog, The Haystack, as well as their Newscripts feature.

For the latter, Dr. Drahl pointed us toward a recent “Crosstalks” paper in Chemistry & Biology by Thomas U. Mayer and Andreas Marx of the University of Konstanz (and her interview with the authors) who mused as follows from their abstract:

Which five molecules would you take to a remote island? If you imagine yourself as a castaway on an island you might pick water, glucose, penicillin, and ethanol in combination with aspirin. However, as a scientist, you may ask yourself which molecules impressed you most by their chemical or biological property, their impact on science, or the ingenuity and/or serendipity behind their discovery. Here, we present our personal short list comprising FK506, colchicine, imatinib, Quimi-Hib, and cidofovir. Obviously, our selection is highly subjective and, therefore, we apologize up front to our colleagues for not mentioning their favorite compounds.

The authors pose two different questions: a) Which molecules, drug or not, would you take as the sole occupant of a desert island? and b) Which drugs most impress you with their chemistry, biology, or impact on science?

The full paper (PDF) is freely available at the time of this post (thank you, Cell Press!) and the science historian in me is delighted by reading it. I’ll be giving this out to my pharmacology students on day one of the upcoming semester and charge them with selecting and justifying a molecule of their own.

She’s now asking for people to fill out this survey of their own five molecules to take to a desert island (or drop comments on her blogpost).

We approached the question as: “What five drugs would you take to a desert island if you were the sole occupant?”

My thought process was to think about what would be most likely to kill you if you were alone as an otherwise reasonably healthy mid-40s dude coming off a bout of pneumonia. Antibiotics and vaccines have arguably had the greatest impact on the leap in life expectancy observed during the 20th century. Vaccines wouldn’t be necessary if you were alone, but antibiotics would be crucial, especially if you fell and broke bones.

But what antibiotic? One probably wouldn’t be encountering highly drug-resistant bugs so would ampicillin be best? Would you want two antibiotics? Perhaps one antibacterial and one antifungal, the latter giving the humid, tropical climate.

For any sort of painful encounter, I’d want morphine. Yes, it’s best injected and I don’t think one would be stranded with syringes as well, but there are oral morphine formulations that have reasonable bioavailability. Perhaps it would be good enough mixed in with coconut milk. If not, I’d take Actiq fentanyl lollipops or hydromorphone.

A good, daily analgesic might help. Aspirin has a lot of advantages despite the evolution of other analgesics like ibuprofen and naproxen.

I’m not sure how my asthma would be on a desert island, but I’d rather not chance it so I’d definitely use up a slot with my rapid-acting beta2-agonist, albuterol.

And if you have a strong, penetrating family history of depression like me, I’d bring an antidepressant -– probably escitalopram. Think that’s not necessary? If you can’t even get up and go fishing or build a shelter because you are so paralyzingly depressed, an antidepressant drug could be just as lifesaving as a broad-spectrum antibiotic.

Ahh, but malaria –- maybe I’ll keep the morphine but give up the naproxen and bring some chloroquine.

This is kind of tough, eh? Some of the choices depend on your own pre-existing conditions.

What five drugs would you bring if stranded on a deserted island?

*This blog post was originally published at Terra Sigillata*


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