So I worked in pharma industry as chemist, and yep this is right to a degree. Scientist start with a hypothesis of how a disease or condition is caused, and then target treatments based on that hypothesis. We start with literally 1000s of potential chemical compounds that might be effective on that hypothesis. That gets whittled down and down, and then more so as go through clinical trials , until you have maybe one that can be registered, and most of the time none at all! But a drug can’t be licensed without some scientific hypothesis of how it works as well as safety, efficacy, data.
so drugs are based on hypothesis and then are proven to work better than a placebo . But it’s hard to prove, outside of stuff like antibiotics and vaccines how they actually work especially where we don’t know the exact pathway of a disease. It is theoretical in most cases.
but I’d argue it DOES matter how they work. As would most scientist in the industry. It is vital that drugs continue to go through studies over the course of their “lifetime”, and that the hypothesis they’re based on is challenged. Otherwise we’d never improve the drug treatments we have. All drugs are a balance of risk (counter indications) vs benefits, and that can always be improved on with newer treatments. Even paracetamol has very significant side effects, so we still aren’t a holy grail of a good over the counter pain killer that has no side effects.
So example of this: interesting the whole class of newer SSRI anti depressants have now been shown not to act in way we thought when they were discovered in late 1980s. The whole notion of depression being caused by interference in serotonin uptake is under doubt. Now we know these drugs work better than placebo , but we now have absolutely no idea for sure how they are working- and calling them SSRIs is now a bit of a joke 🤷🏼♀️. But finding this out means is opens up whole new theories of what does causes depression, and how that links to the fact that SSRIs DO have an effect. That’ll help us develop better drugs, more targeted, and hopefully less side effects.
some modern and older medications were derived form natural remedies that have been in use since pre medieval times. In fact the drug Tamoxifen is deceived from Yew trees (literally the drug company collected yew cuttings for years until recently) based on “old wives tales” of helping breast cancer. Salicylic Acid is found in willow and has been used to treat pain for probably millennia and the raw chemical was isolated in late 1800 for first time under brand name Aspirin. Truly a wonder drug in helping not only pain, but heart conditions and potentially cancers. But still no one quite knows how it works
in centuries to come, many of the drugs we use now will be regarded as either a joke or outrageously stupid, as medical knowledge progresses and we learn more about the pathways that cause certain illnesses and diseases.