The biological properties of the lanthanides, based on their similarity to calcium, have stimulated research into their therapeutic application. Historical medical uses of the lanthanides and recent advances and successes will be described in the context of the biological chemistry of lanthanides, including a new metal-based drug, lanthanum carbonate, which has recently been approved as a phosphate binder for the treatment of hyperphosphatemia. This tutorial review will be of interest to those working on metal-based drugs, including inorganic chemists, and biological scientists.