CEP: Editorial - More Than a Spoonful of Sugar

Many of us remember receiving our polio vaccine on a sugar cube. Indeed, that was the motivation behind A Spoonful of Sugar, a song from the classic Disney movie Mary Poppins. Walt Disney had instructed the Sherman brothers, Robert and Richard, to come up with a catchy song for the film. When Robert arrived at home, after working all day trying to come up with an idea, his wife told him that the children had gotten their polio vaccine that day. Thinking they had gotten a shot, he asked them if it hurt. His son answered that the medicine was put on a cube of sugar and he swallowed it. And so “a spoonful of sugar helps the medicine go down was born.

Over the years, drug manufacturers have employed various strategies to make their medicines go down more easily. Many tablets are coated to make them easier to swallow. The enteric coating on many aspirin tablets controls the location in the digestive system where it is absorbed; the coating is stable at the highly acidic pH found in the stomach, but breaks down rapidly in the alkaline environment of the small intestine, thereby helping to prevent the stomach upset that aspirin causes in some people. And what parent doesn’t know that amoxicillin is bubblegum-flavored to make it more acceptable to a baby?

Of course, getting the medicine down is only part of the battle. The right amount of drug must get to the right place at the right time for the right duration. In the first article of this issue’s SBE Supplement (pp. 17–40), John Santini points out that this is the goal of any drug delivery system. He explains that many of the newer drugs in development are significantly larger than the small-molecule drugs traditionally given by mouth. Macromolecules, such as anti-bodies and proteins, tend to be less stable than small molecules and can lose their activity if they are not processed or stored properly; thus, much of the innovation in recent years has focused on how to deliver macromolecules to the body. The other articles in the supplement explore some emerging technologies for drug delivery, including engineered nanoparticles that can deliver therapeutic agents to specifically targeted cells and then release those agents in a precisely controlled manner; microfluidic catheters to overcome the blood-brain barrier and deliver neurological drugs directly to the brain; and bioactive implants that combine a medical device with one or more biologic agents.

We schedule the SBE supplements far in advance, so any relationship between the supplement topic and current events is coincidental. An article in the Nov. 2010 SBE Supplement on stem cell engineering discussed bone tissue engineering and the use of platelet-rich plasma to treat stress fractures; when we received the manuscript, I was working from home while the stress fracture in my tibia healed. So it’s no surprise that as we are preparing this issue, I’m fighting a respiratory infection and have tried a variety (not all at the same time) of over-the-counter and prescription treatments — a decongestant, an expectorant and cough suppressant in tablet form, two different oral anti-biotics, a nasal spray antihistamine, two different liquid cough suppressants, throat lozenges (and chicken soup).

I can attest that sugar does help, but only for a few minutes (chocolate’s soothing effect lasts a little longer). Oh, how I wish there were a multifunctional therapeutic agent encapsulated in a nanoparticle that could cure me without any side effects or nasty aftertaste.