Finasteride: The Gary and Jerry Show

Way back in chapter 1, I told the story of how I jumped from the world of academic science, which I understood, to that of drug discovery and development, which I did not. So I knew there was a lot of learning to do on my part if I was to contribute anything to Merck Research (and continue to find a way to feed my family), although I underestimated the extent of my ignorance. Here is the way it started. I showed up for work at Merck Research on January 3, 1979, and met with Ralph Hirschmann, my boss, in his office to get a sense of his expectations and my marching orders. Among other things, he informed me that the benign prostatic hyperplasia (BPH) project was among my responsibilities. At that point, I began to understand just how much I needed to learn. The BPH project had been under way for some years at the time I joined Merck. Coming in, I knew a lot of general biochemistry and physical organic chemistry. I knew less about human physiology and less than that about human diseases and medicine. Among areas of my ignorance was the disease BPH, for which I was now responsible on the biology side. Later, I became the BPH preclinical team leader. BPH is medicine’s shorthand for benign prostatic hyperplasia, the benign growth of the prostate gland in aging men. Hyperplasia refers to an increased number of cells in an organ, with consequent increase in organ size, as a result of too-frequent cell division. BPH stands in contrast to the malignant growth of the prostate gland—prostatic carcinoma—a potentially life-threatening cancer. BPH is not life-threatening, but it is surely a condition that compromises the quality of life of men who have it. Lets get started by having a look at what goes wrong. In normal young men, the prostate gland has a volume of about 20 mL and is roughly the size of a walnut.