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Perry Mason, M.D.

June 09, 2002

Nothing focuses the attention quite so promptly as a sudden, serious pain, especially a sudden, serious pain in the upper body. We're not talking problems of the heart here; we're talking heart problems. Unfortunately, heart conditions are endemic in our society. Every year 300,000 new patients develop angina--severe chest pain caused by constriction of blood vessels feeding the heart.

It's one of those grand medical ironies of history that relief from the awful squeezing pain of angina came to millions not from white-coated doctors in pharmaceutical labs but from the rougher commercial crowd that brought us dynamite, the indelicate explosive that does the opposite of constrict things. You may recall dynamite's inventor was a Swede named Alfred Nobel, whose stunning PR makeover, from Dr. Death to philanthropic creator of the Nobel Peace Prize, could inspire currently troubled public figures.

Some 19th century doctors noticed that dynamite workers with angina were free of symptoms until they returned home each night. Imagine feeling better at work. But the relief was traced to nitroglycerin, an element of dynamite floating in factory air.

Nitro was refined into sprays, patches and a pill which, when placed under the tongue, dissolves and in just three endless minutes relaxes the tightened veins to erase the pain. This is great stuff. In fact, nitroglycerin is so cheap and effective, it's regularly among America's top 100 medicines.

For The Record
Los Angeles Times Friday June 28, 2002 Home Edition California Part B Page 14 Editorial Pages Desk 1 inches; 50 words Type of Material: Correction
Nitroglycerin and angina--An editorial June 9 partly misstated the role of mitochondria in the newly discovered metabolizing of nitroglycerin in angina patients. Mitochondria are subcellular organelles composed of many molecules, including enzymes, one of which metabolizes the nitroglycerin.

But during 130 years of ensuing marvelous medical progress, until this last week no one knew exactly how nitroglycerin worked. Such a medical mystery, actually, is not a unique phenomenon. No one understands how aspirin, morphine and digitalis perform their medical miracles. Who cares, you say. If you're benefiting from, say, morphine, you're not really into dissecting how it works.

But here's what Dr. Jonathan Stamler and his fellow Duke University medical detectives finally figured out and wrote up for the National Academy of Sciences: Mitochondria, key molecules within every cell, act as catalytic enzymes. They convert the nitroglycerin to nitric oxide, which relaxes the uptight blood vessels. This discovery won't change the world as dynamite did. But if you ever do need nitroglycerin, it's amazing how quickly those little mitochondria earn gratitude so much larger than they are.

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