Historical Consequences
The heritage of Orinase (tolbutamide) has had a lasting effect on medicine and the pharmaceutical industry. Patients today are still diagnosed with prediabetes, many of them managing to stave off the onset of diabetes through dietary and lifestyle changes. But many also have the option to take Bristol-Myers Squibb's oral antidibetic medication Glucophage (metformin), which demonstrated a 31 percent reduction in three-year incidence of development of diabetes relative to placebo. While impressive, the lifestyle-modification arm of that same trial demonstrated a 58% reduction. (Diabetes Prevention Program Research Group)
Orinase was one of a number of drugs developed during the 1950s and 1960s for a variety of conditions first to treat symptomatic diseases and later to treat asymptomatic conditions that put the patient at risk of developing symptomatic disease. Its use and marketing played a definitive, though not solely sufficient, role in establishing the condition of prediabetes as a legitimate diagnosable condition. As such, it illustrates that science, medicine, markets, and health can interact in complicated and fascinating ways that are neither clearly desirable nor undesirable.
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