SCOTT SIMON, Host:

Thomas Hager joins us now from Eugene, Oregon. Mr. Hager, thanks so much for being with us.

THOMAS HAGER: Thank you for having me.

SIMON: And it's fascinating to learn in your book that as late as the 1920s, there were only about a dozen drugs that reliably worked. Drugs weren't part of medical care.

HAGER: It's difficult to think now in terms of what our grandparents and great grandparents experienced when they were growing up. In those days, before 1931-'32, every year in America huge epidemic swept through American cities, carried away tens of thousands of people. There was really nothing that anyone could do until the discovery of these drugs.

SIMON: Explain to us how the development of sulfa drugs really came out of the catastrophic loses of World War I, and not just combat deaths, but battlefield deaths in which bacteria were responsible.

HAGER: The surgeons working under terrible conditions did fabulous work sewing up these torn apart men. And then Domagk and the surgeons would watch as a week later, in case after case, an infection would set in, the wound would get infected. There is nothing that could be done for a wound infection. Dozens and dozens of men died before his eyes and the eyes of the physicians there, and hundreds of thousands died worldwide from wound infections. And the problem was, of course, that despite what you did in terms of cutting and sewing, there was nothing you could do to stop bacteria from infecting a wound and killing these soldiers.

SIMON: How was it that the discovery of sulfa drugs was rooted in dyes, D-Y-E-S?

HAGER: Domagk had been looking for a dye to cure disease at Bayer for four years, testing hundreds and hundreds of dye molecules without a single success. When in 1932 he was given a new dye molecule - the chemists had given him one that had a tiny little side chain attached to it that they hoped might make the dye stick better to the bacteria. When he tested that dye molecule, it suddenly worked. The little side chains somehow cured disease, and it'd been sitting on the shelves of chemists in the dye-making industry for 20 or 30 years, by the bagful. It was called sulfanilamide, and that was what kicked off this boom. The ironic thing, of course, is that sulfa is not a dye at all.

SIMON: And in fact, there were two British scientists who established that - I think your nice phrase is it wasn't a magic bullet but a clever impostor.

HAGER: It was. No one could figure out how it worked until some years later, when British researchers figured out that it mimicked a food substance for bacteria. Bacteria would eat the synthetic chemical instead of the food they needed, and essentially they would starve to death.

SIMON: When sulfa drugs were developed, they sure moved around the world quickly, didn't they. And we think that sort of thing can only be done now, but this was an extraordinary testament to industry.

HAGER: And the average lifespan for Americans increased by more than 10 years. So demographers call this the great mortality transition, and that's a very important turning point in human history. That started with the discovery of these drugs.

SIMON: Could I ask you more about Gerhard Domagk? He was not a Nazi. He's not a member of the party and in fact he refused to return the Heil Hilter salute, and yet he worked for a company that used slave labor.

HAGER: Well, Domagk did what I think many Germans did at that time. He focused entirely on his work, hoping that the good that he would in the world would outweigh whatever, politically, was going on. When he won the Nobel Prize, in Germany at that time, the significance...

SIMON: Now was 1930...

HAGER: 1939. He was hoping that he could accept it, but instead the Gestapo came to his door and arrested him and threw him in jail for a week.

SIMON: For a drug that changed so much in the course of history, sulfa drugs had an astonishingly small window.

HAGER: They did. This spurred more research into this field of magic bullet medicines like sulfa. People returned to penicillin, which they had sort of given up on. And pretty soon we had penicillin, and then there was streptomycin. And we were in the middle of what's called the antibiotic revolution. And as these new antibiotics came on the scene, everyone forgot about sulfa. It had about a 10-year run.

SIMON: Sulfa is still used, though, isn't it? Because there are some people that just don't respond to penicillin.

HAGER: And it's important to realize the danger of antibiotic resistance now is growing so fast that I am beginning to worry that we're nearing the end of that golden age.

SIMON: Mr. Hager, thanks very much.

HAGER: Thank you.

SIMON: Thomas Hager. His new book is "The Demon Under the Microscope."

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