Breakthrough: The Quest for Life-Changing Medicines

by Dr William Pao

Meet the doctors, scientists, patients and campaigners tackling the world’s worst diseases

We often hear about the dark side of the pharmaceutical industry – from extortionist pricing to the opioid epidemic. But there’s another story to be told.

Through the story of eight revolutionary treatments, Dr William Pao cuts to the innovative heart of medical science and celebrates the tireless work of those fighting for better care. Behind each of these medicines – whether a potentially life-saving new treatment for cancer, or something as commonplace as paracetamol – there stands a cast of characters and a wealth of stories.

The trajectory from the laboratory to the local chemist is rarely a straight line. Eureka moments are few are far between. Drug hunting demands leaps of imagination and lateral thinking, the accumulation of the knowledge and expertise of many, and – nearly always – a hefty dollop of luck.

Breakthrough documents these journeys and grants a privileged look at the stories behind the medicines that improve – and very often save – our lives.

Genres: Science, Nonfiction

371 pages, Kindle Edition

Published October 3, 2024

Reviews

[Nghi · Rating 5 out of 5]

If you ever want to know how laborious and exciting and complex drug development is, Breakthrough is an inspiring read, even for someone like me who spends his career in biotech.

I can honestly say this book blew my mind. The way Pao walks you through the intricate world of drug discovery and the tireless work behind each breakthrough is nothing short of awe-inspiring. I will be buying this book for all my friends jn 2025.

There were several moments when I found myself completely captivated by the resilience, innovation, and sheer determination required to bring a drug to market. Pao’s writing is not only clear and accessible, but also deeply engaging, making even the most technical subjects easy to follow and fascinating.

Three chapters stood out in particular for me: the one on spinal muscular atrophy, the one on hemophilia, and the one on HIV. Each chapter dives into the science and human stories behind these diseases and their treatments with such depth that I felt a true sense of the lives at stake and the decades of hard work required to deliver transformative medicine.

What really sets this book apart, though, is Pao’s ability to explain complex scientific concepts in a way that feels both insightful and accessible. His ability to distill years of research and innovation into such a compelling narrative is truly a gift. If you’re interested in the future of medicine or just want to understand the monumental achievements in drug development, Breakthrough is an essential read.

[Thomas Stroemquist · Rating 5 out of 5]

I'd recommend this excellent and accessible book on drug discovery and development. Pao has managed to write a science heavy book that is both engaging, thrilling and awe inspiring. Whether you work in the filed, or are even a tiny bit curious, you'll thoroughly enjoy this.

It's not flawless, for someone oriented in biochemistry, the explanations are spotwise a bit too basic and for someone brand new to it, I'm sure at times not in-depth enough. But tending to both, I'm not sure it could be done much better. The inspiring narrative and personal perspectives though, is not something you'll find in a text book on the subject.

Relating the stories of 8 cutting edge drugs and how they came to be, through all the pitfalls and need for innovation in multiple areas to get there, the dead ends, the unexpected pitfalls, the random discoveries along the way, it manages to both inspire and to be a great primer.

[Ryan Gidda · Rating 4 out of 5]

Goes into great detail on the fundamental science behind recent drug developments, as well as consistently keeping it clinically relevant to the patients and conditions we’re treating. 100% recommend

[Kathleen · Rating 4 out of 5]

Breakthroughs in drug developments tackling eight major illnesses, including COVID. Each is described in chemical and biological details which I found difficult as my science background is so low, but understandably enough for me. His emphasis is on the long background of many teams working in different fields which can enable eventually a usable drug. He writes from a base in “ Big Pharma” but shows why the enormous R and D investments are necessary. As I read a book a while ago on the race to develop the Astra Zenica COVID vaccine, centred in Oxford and academia, I was aware that his account of the Pfizer antivirals was not giving full weight to academic research, though I am aware that that too is fighting for budget and subsidies just as pharmacological giants are. There was also- this was not the book for it- no exploring of the ethical questions that arise with drug developments. People who rail against Big Pharma or are absolutists about any use of any animals in any research will hate this book. But there is an enormous amount of information not absorb and ponder in these pages.

[TK · Rating 4 out of 5]

This book reminds me of The Emperor of All Maladies, a masterpiece by Siddhartha Mukherjee, specifically the (meta) parts about science, and how this is constructed. It's hard to believe people spend years and sometimes decades to find a medicine that targets a specific disease. The amount of effort, energy, time, and resilience required to keep working, keep failing, and finally have a breakthrough is outstanding. On the other hand, it's fascinating how science is unpredictable and interdisciplinary: decades of work from multiple people that come together over time. As Teresa Klinowska says about iteration in the innovation process, "These things don't come from nowhere. They come from good people having great ideas but working on knowledge accumulated in the past".

Frances Arnold: "If you're going to change the world, you've got to try really different things." — in her The Nobel Prize interview. It's impressive how, in her speech and in the book, there are fearless and adventuresome people who come to the lab knowing nothing, and they learn, they try new things, and eventually, they change the world. Fascinating that sometimes we put barriers in front of us. A common one is adding pre-requisites to do work and research. Of course we need foundation knowledge, but we should just start, learn, and keep making progress on the fields we are interested about.

The last chapter about how to innovate is also interesting and worth reading for anyone in science.

[lisa · Rating 4 out of 5]

This brave man valiantly attempts to explain chemistry to the general public in the setting of medical breakthroughs. A must read for anyone interested in learning how new therapeutics are created- that is to say, no one. But he does a great job simplifying and storytelling the issues, without bias as well.

[Lillian · Rating 4 out of 5]

I was most interested in Chapter 8 knowing how much work and how many people contributed to the discovery of and development of lenacapavir, however I found myself getting caught up in all of the stories of drug development across very different diseases and types of treatment. William Pao describes research and drug development in a very accessible and interesting way.

[Grant · Rating 5 out of 5]

I just finished Breakthrough and I thoroughly enjoyed it. As someone who has spent 29 years in the pharma / biotech industry, it is the best book (for the general public) I have ever read on the process of drug discovery and development. Thoughtful stories of science, strategy and perseverance over a broad range of modalities and therapeutic areas.