For thousands of years, humans have sought cures for and symtomatic relief from disease. Initially, remedies relied heavily upon spontaneous remission of disease and the placebo response. However, during the nineteenth and twentieth centuries, a more systematic approach was taken to drug development that resulted in some medicines having greater efficacy. Nevertheless, around three-quarters of the medicines that were licensed in 1975 had disappeared by 1990 when the work of the Committee on the Review of Medicines was concluded.The increased effectiveness of drug therapy came at a price, namely that of adverse drug reactions, some of which occurred despite pre-clinical and clinical toxicity testing. In practice, many adverse reactions could be predicted from the known pharmacological properties of the drug in question. They tended to occur when the normal pathways of elimination (metabolism and renal excretion) were compromised − as in the elderly. However, others were unpredicted and led to the need for new systems of pharmacovigilance.It has been common to downplay the contribution of medicine to the average 30 years of life added during the twentieth century. Nevertheless, the prevention and treatment of infectious diseases and those affecting the cardiovascular system represent considerable successes. However, where improvements in psychotropic drugs have improved mental health, they have been widely over-prescribed. The concept of a panacea is therefore rejected, as is that of a polypill for cardiovascular disease.Looking to the future, the following needs are identified: a well-educated medical workforce, able to make an accurate diagnosis; a workforce capable of individualising drug therapy based on knowledge of pharmacokinetics and pharmacodynamics; better public understanding of medicines; improved ways of explaining risk (and risk benefit); and better/additional techniques of pharmacovigilance.