The Swiss Army Knives of Drugs

Have you ever stopped to think about which 10 books you would want if you were stranded on a desert island? A quick internet search turns up lots of lists and most of them have titles that start with "The Complete Works of …." (A few list makers even take the approach that a boxed set should count as one book, which opens the possibilities even more.) All the list makers have the same approach: Get as much from a single book (or boxed set) as you can.

If you were making a list of the 10 tools you'd take to an island, chances are one of them would be a Swiss Army knife – maybe the one with the needle and thread and writing paper or the SwissFlame, which includes a gas lighter.

And, if you were packing a medicine kit, there's a good chance you'd follow the same principles – find the drugs that will treat the most ailments.

But just as there are rules for the books you can take (you can have The Complete Works of William Shakespeare because they've been published in one volume, but you can't have a complete set of Tolkien because his works haven't yet been scrunched together in one binding), there are rules for the medicine cabinet. You want the drugs that not only have the most uses, but those that have been proven effective. For practical purposes, that means they have to be approved for use by some governmental authority with a panel of experts who can review the results of well-controlled studies.

1) Aspirin

The first choice has got to be aspirin. This is probably the most versatile drug known. Although it's best known for the treatment of aches, pains, and fever, that's really just the start. In low doses it's used to reduce the risk of heart attacks and strokes. High doses have an anti-inflammatory action that's useful in rheumatoid arthritis, tendonitis, and bursitis. While osteoarthritis rarely causes inflammation, aspirin may help this type of pain as well. Don't go to a deserted island without a bottle of aspirin.

Oh yes – even when aspirin deteriorates, all isn't lost. When aspirin breaks down it becomes acetic acid (vinegar), which can be used to treat ear infections, and salicylic acid, which is used to treat acne, dandruff, warts, corns, and other skin conditions. So even when aspirin goes bad, it can still do some good. What more can you ask of any drug?

2) Tetracycline

You might want to consider a bottle of tetracycline – a widely used antibiotic sold under the names Achromycin V and Sumycin. There are lots of tetracycline derivatives available, such as minocycline and doxycycline, and they have advantages in specific cases, but none have been as versatile as the original. Not only is this drug a wonderful antibiotic – effective against a large number of infectious diseases – but it has other uses as well. There's hardly a place in, or on, the body where you can't find a use for tetracycline. Applied to the skin or taken by mouth, tetracycline can be used to treat acne. A tetracycline-impregnated string can be placed inside the gums to treat gingivitis. It's valuable for infections of the eyes, ears, skin, urinary tract and for treatment of sexually transmitted disease. In combination with a bismuth product like Bismatrol, Bismed or Pepto-Bismol, tetracycline is a cure for recurrent gastric ulcers.

3) Methotrexate

Feel like taking chances? Methotrexate (sold as Folex or Rheumatrex) may not be a safe drug, but it is versatile. The drug was originally developed for treatment of cancers of the head, neck, lung, breast, and some types of leukemia. Methotrexate is also one of the most useful drugs for the treatment of psoriasis and has a role in the treatment of rheumatoid arthritis. Consider this one for your island sojourn, just in case.

4) Diphenhydramine

You'll want some diphenhydramine (Benadryl). Here's a drug that can be used for stuffy noses, sneezing, itching, nausea, vomiting, and vertigo – you will definitely want some diphenhydramine. It's a valuable sleep aid in insomnia and has a place in the treatment of eye inflammation. Besides that, diphenhydramine can be useful in controlling persistent coughs and may be helpful in both Parkinson's and extrapyrammidal diseases. Swallow it, inject it, or spread it on your skin, you'll almost certainly find something that diphenhydramine is good for.

5) Hydrocortisone

The real Swiss Army knife of drugs is hydrocortisone, a compound that can be given by mouth, vein, enema, or suppository or applied to skin, eye, or ear. The brand names for this product alone could fill a page, running alphabetically from Aacicortisol in Belgium to Westcort in Canada and the United States. Hydrocortisone is included, in some form, in every national pharmacopoeia in the world.

The list of its uses is so long that the diseases have to be grouped together: cancers (both solid tumors and cancers of the blood); skin problems (such as contact dermatitis, atopic dermatitis, and exfoliative dermatitis.); respiratory diseases (such as allergic rhinitis and bronchial asthma); and autoimmune diseases (such as systemic lupus erythematosus). Hydrocortisone is used to treat some anemias and is a staple of organ transplant surgery. It's valuable for treatment of tapeworm infestation and several types of arthritis including rheumatoid and psoriatic. Hydrocortisone is standard treatment for cerebral edema (swelling of the brain). It's used to treat the heart in rheumatoid carditis and the bowel in Crohn's disease. Though hydrocortisone inhibits the immune system, it has been proven valuable for treatment of disseminated systemic tuberculosis.

The ancient herbalists (and even some modern) used to look for specifics: a single herb to treat a single disease. At the start of the 20th century, the great German researcher Paul Ehrlich looked for "magic bullets." But some of the best drugs have more in common with shotgun shells – they cover a broader area. Keep that in mind, if you're ever packing for a stay on a desert island.

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