The pharmaceutical world is about iteration, progression and constant improvement, with prescriptions and treatments changing in line with evolutions in medical knowledge.
To paraphrase economist John Maynard Keynes, when the information changes, so too do the conclusions.
This means that when a GP prescribes a medicine to collect through the NHS electronic prescription service, it is chosen because there is a wealth of evidence and multiple stages of clinical trials that demonstrate that it is safe and effective for the condition being treated.
This process is part of the reason why early historic medicines are so shocking to modern observers.
The notion that cocaine cough drops were sold to children or that heroin was sold as a safer, more effective alternative to morphine or opium is almost impossible to understand, and this highlights the speed of progress in the medical world.
It also means that even patent medicines that are ineffective to the point of being effectively snake oil can make a positive impact, and one of the most unusual examples of that is in the strange case of Lydia Pinkham and her Vegetable Compound.
Breaking The Silence
Born Lydia Estes in 1819 as part of a family who were friends with abolitionist leader Frederick Douglass, her early life was driven by activism and academia, working as a teacher and supporting feminist and abolitionist Nathaniel P. Rogers until 1843 when she married Isaac Pinkham.
She brewed home remedies using books such as American Dispensary by John King as an aid, benefitting from a lack of wide availability of pharmaceutical medication at the time.
However, whilst these remedies were initially provided to neighbours and friends, the effects of the 1870s economic depression turned her Vegetable Compound into a family business, and from 1876 until the early 20th century, it was one of the most popular patent medicines available.
None of this had to do with the efficacy of the compound itself, which used fenugreek, pleurisy, black cohosh, life root and unicorn root mixed with a significant amount of drinking alcohol. In 1922 it was described as a “valueless preparation”.
Much like Mrs Winslow’s Soothing Syrup, any pain-killing effects likely came from the significant alcohol content within it.
However, what made it make a positive difference to the medical world was to break stigmas and taboos for women to discuss medical problems which, at the time, were somewhat awkward to discuss with a doctor, a field overwhelmingly dominated by men at the time.
The “women’s tonic”, as it was advertised, aimed to treat menstrual cramps, conditions caused or exacerbated by the menopause and other conditions that were simply not discussed at the time.
One of the most notable parts of its marketing was a call to action for women to write to “Mrs Pinkham” directly to get a response, with a promise that no men would read it.
This provided a space for gynaecological concerns to be talked about during a time when there was a culture of science surrounding feminine health.
Whilst this in no way excuses the ineffectiveness of the medicine itself or the unscrupulous marketing tactics of having “personal letters” from Mrs Pinkham sent to prospective customers nearly three decades following her death in 1883, it provided the first tentative steps towards gynaecology.