From so simple a beginning…

In the 1930s, the United States Food and Drug Administration was a mere shadow of its current incarnation, skimpy and ineffectual, with a few dozen agents scuttling around mainly trying to curb excessive profit-making within their limited jurisdiction. There were no laws that needed drug manufacturers to list all ingredients, no laws that called for extensive and separate testing for all ingredients of a drug for toxicity and side effects, and no laws that required separate testing everytime somebody made what he thought was a “small” modification to an existing drug formulation.

A single incident changed all that. During this period of political turmoil in the world, sulfa drugs had become the rage, the first true antibiotics that served as frontline defenses against a variety of bacterial infections, infections spread through simple cuts and bruises against which people could do nothing before, simply waiting and praying for the patient to get well…or to die. In the mid 1930s, a bright red formulation of a sulfa drug made its appearance in the US market. Touted as an excellent remedy against throat strep infections and other similar maladies, it was rapidly taken up by the population and administered generously to children and adults. But within a few days, disturbing reports began to come in, and people started dying. The chief pharmacist in the company responsible for the formulation committed suicide, and the FDA was given complete charge of stopping the spread of the poison as it made its way through ten states and into the shops and the bodies of unsuspecting pharmacists and customers. Within a couple of weeks, a horrible wave of death spread across the country, claiming more than a hundred lives before all shipments of the drug were located and confiscated. It was a sobering lesson for the entire nation, congress reacted with unusual efficiency and speed, and thus was born the modern FDA; an all-encompassing agency that has spread its jurisdiction meticulously over almost every medicinal substance manufactured in the US. Drug laws were revamped and made stricter than ever before, necessitating the extensive testing for side-effects of every component that is a mainstay of the drug industry today.

But what was the cuplrit that had wrought this social disaster and reform? A single simple substance that was used only as a solvent to dissolve the beneficient sulfa drug- ethylene glycol; a colourless, syrupy sweet liquid used for decades as an industrial solvent, air-conditioner fluid and deicer for window panes. The ethylene glycol used for the sulfa drug formulation coursed through its victims’ bodies, rapidly generating toxic substances that attacked cells, proteins and DNA. Death usually came slowly and painfully. Since then, ethylene glycol has been listed as a highly toxic substance that needs to be kept away from all consumables.

But more patients’ lives could perhaps have been saved by a curious treatment; sweeping their system by an IV drip of ethanol, or as many human beings call it, “saturday night fun”. More simply, one could have saved their lives by getting them drunk. Even a drip of wine would technically have helped. Ethanol prevents the body from accumulating ethylene glycol and interacts more favourably with the enzyme that is responsible for metabolising ethylene glycol into toxic substances. Ethanol, the vice that has tempted humanity for centuries and that has been proscribed (mostly hypocritically) in almost all religious texts, can be a life saviour in such situations.

As ethanol can save the life of the stricken, so can it save those of the stupid. About only 10 ml of methanol, a close cousin of ethanol that is used extensively in academic and industrial laboratories of all kinds, can cause blindness. As less as 30 ml can and will kill you. It does so by two means. First, by again reacting with the enzyme that usually metabolises ethanol, it produces substances far more toxic than those produced by metabolising ethanol. One of the metabolities, formaldehyde, is a reactive substance par excellence, attacking almost every biomolecule it sets sight on. Secondly, methanol depresses the central nervous system, again similar to what ethanol does, finally depressing it enough to gag the respiratory center in the brain. If not anything else, this should indicate the dangers of ethanol, whose effects are so similar if not as exacerbated as those of methanol. But the cretinous persist. In their desperate throes to search out ethanol, a fine taste for which they have acquired through many evenings of gaiety, they can sometimes imbibe methanol in the hope that it will satisfy their ethanolic urges. Alas, what for a chemist is a difference of only one carbon translates to a difference of life versus death for these intrepid seekers of satiation.

As much as we may frown upon these trouble makers who shoot themselves in the foot, we have responsibilities to save them. The same drip of ethanol that can save ethylene glycol-ridden victims can do that same for the methanol-afflicted. The next time you suspect somone of having consumed methanol, thrust a bottle of your finest wine down his or her throat. Fortunately for us, the enzyme that metabolises both methanol and ethanol has a much greater affinity for ethanol. Fortunately too methanol is more volatile and water-soluble than ethanol, so while ethanol keeps the enzyme busy, methanol is gotten rid of through the kidneys. In fact, many people have a close call unknowingly when they consume liquors and other spirits; all these liquids have methanol from their natural distillation process, and it is only the more abundant ethanol that keeps the methanol from doing its damage.

In the case of these foolish yet unfortunate members of society, ironically the thing which almost killed them now can save their lives and flows through their arteries as life-giving elixir. Such are the tragic and sometimes happy circumstances that nature and chemistry thrusts upon us.

© Ashutosh Jogalekar