Neville Goodman’s Metaphor Watch: The magic bullet

neville_goodmanThe expression magic bullet is due to the German medical scientist Paul Ehrlich, who was seeking a cure for syphilis. He wanted to find chemical substances with specific affinity for the pathogen. The one that eventually proved effective, which Ehrlich named Salvarsan, was the 606th of a series of arsenical compounds tested, although the 914th, Neosalvarsan, proved more useful.

In a sense, many of our drugs are magic bullets, in that they have special affinity for the receptor or some part of the organism to which they bind, so the expression became redundant long ago. When Ehrlich coined it, there were no specific drugs, so the magic bullet was a dream, to which metaphor is well suited. To speak now of a magic bullet for multiple sclerosis, or for rheumatoid arthritis, is, frankly, a bit dull. There are more incurable diseases than curable ones, and of course we would like a simple drug treatment for them all.

Ehrlich did much work and was an important theorist in the early development of immunology, for which he was joint winner of the Nobel Prize in physiology or medicine in 1908, two years before his discovery of Salvarsan. The modern magic bullet is often an antibody, but I think it unfair on Ehrlich to write, “Although it took over one hundred years, Ehrlich’s concept of the magic bullet is now a reality.” Ehrlich’s concept of specificity became a reality with his discovery.

Taken away from its context of drug receptor interaction, magic bullet becomes a sort of “meta-metaphor”: magic bullet is a metaphor for a specific drug; then becomes at one remove a metaphor for the perfect solution. Yes, “There is no magic bullet to prevent or treat pulmonary complications,” but that says no more than “no single way” or “no easy way.” The opposite of the magic bullet is the blunderbuss. Antibiotics can be either. There are few blunderbusses in PubMed®, and some of them are a metaphor not for treatment but for shape: an apex blunderbuss is an open or everted apex of a tooth, which resembles the barrel of a blunderbuss.

As Fernàndez-Busquets writes, a magic bullet for malaria is unlikely because of the parasite’s life cycle and “the tricks of its pathophysiology,” but in a paper titled, “Toy kit against malaria: magic bullets, LEGO, Trojan horses and Russian dolls,” which in its first paragraph includes holy grail (of which, more anon), the metaphorical treatment of malaria is well under way.

Neville Goodman is a retired consultant anaesthetist and a writer, and co-author of a book on medical English.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that my only competing interest is my co-authorship of a book about medical English.