Unless you are old or chronically sick, it’s likely that the only drug you’ve ever taken that hasn’t been a small molecule is a vaccine. Indeed, drugs that aren’t small molecules are so strange and rare we usually don’t think of them as “drugs” but as a separate entity: vaccines, monoclonal antibodies, anabolic steroids.

But, like, the vast majority of molecules found in our body, and in all of organic life, are not classified as “small”. And the vast majority of the things doing something interesting are not really molecules, but more so fuzzy complexes of molecules (ribosomes, lysosomes, lipoproteins, membranes).

So why are virtually all drugs small molecules? Prima facie we’d expect most of them to be complexes made up of 10s to 1000s of very large molecules.

The answer lies in several things:

• Easy to mass-produce
• Simple to administer
• Cheap to store
• Homogenous in effect
• Quick to act

Medicine is slowly undergoing the process of learning how to work with complex molecules. In parallel with normal medicine, I’d like to think that biohackers with the ability to custom order whatever they can dream of, will lead the way with self-experimentation. Figuring out the limits and benefits from individualized design and continuous monitoring. For now, this is mainly click-bait, people injecting a bioluminescence gene with CRISPR kinda stuff, but some of it isn’t. As an example, the guy from ThoughtEmporium self-designed a therapy to get rid of lactose intolerance (though the solution is not permanent, it lasts for a few months). 100s of other such people are engaging in similar experiments, and the more people do it, the more resources become available, the easier it will get, and the better the ROI. As this happens, social acceptance will follow and pharmaceutical companies will get more on the deal.

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