“The scope of the present National Formulary is the same as in previous issues, and is based on medical usage rather than on therapeutic ideals. The committee consists entirely of pharmacists, or of men with a pharmaceutical training, and it cannot presume either to judge therapeutic practice or to follow any particular school of therapeutic practice. The question of the addition or deletion of any formula was judged on the basis of its use by physicians and its pharmaceutical soundness. The considerable use by physicians of any preparation was considered sufficient warrant for the inclusion of its formula in the book, and a negligible or diminishing use as justifying its exclusion.”
“The scope of the present National Formulary is the same as in previous issues, and is based on medical usage rather than on therapeutic ideals. The committee consists entirely of pharmacists, or of men with a pharmaceutical training, and it cannot presume either to judge therapeutic practice or to follow any particular school of therapeutic practice. The question of the addition or deletion of any formula was judged on the basis of its use by physicians and its pharmaceutical soundness. The considerable use by physicians of any preparation was considered sufficient warrant for the inclusion of its formula in the book, and a negligible or diminishing use as justifying its exclusion.”
Part I of the volume contains formulas, good, bad and indifferent, including the equivalents of a large number of shotgun proprietaries. Part II contains descriptions of drugs. This is a new feature. The purpose is toprovide standards for those drugs not described in the Pharmacopeia but used in N. F. preparations. Many of these drugs were described in the U. S. Pharmacopeia VIII, but have not been included in the ninth revision. Practically all are either worthless or superfluous. Part III contains descriptions of special tests and reagents.
Among the therapeutically useful formulas are those for aromatic castor oil, emulsion of castor oil, sprays or nebulae, solution of aluminum acetate, solution of aluminum subacetate and wine of antimony. The two last named are also included in “Useful Drugs.” Several formulas for new classes of preparations which may or may not be found superior to old forms are paste pencils for the application of medicaments to limited areas of the skin, mulls, which are ointments spread like plasters, and fluidglycerates, which are fluidextracts in which glycerin takes the place of alcohol. It should be noted also that, as a result of criticism, the alcohol content of some preparations has been reduced.
As a whole, the present edition of the National Formulary, like its predecessors, is “pharmaceutically useful but not a therapeutic necessity.” To say that it is not a therapeutic necessity is to state the matter mildly, since most of the formulas and almost all of the drugs described have been discarded long since by rational therapeutists. So long as there are physicians who prescribe therapeutic monstrosities, however, the druggist should have the aid that is furnished by this book in compounding them. From the pharmacist’s point of view, therefore, the book is a valuable one. Physicians who have a scientific training in the pharmacology of drugs will not want it; others will be better off without the temptations offered by its many irrational formulas.—(Book Review in The Journal A. M. A., Sept. 2, 1916.)
The treatment by nonspecific methods in a series of cases of influenzal pneumonia has been the subject of two recent papers.295These methods are a development of the work of Ichikawa, Kraus, Lüdke, Jobling and Petersen, and others on the treatment of typhoid fever and of Miller and Lusk’s work on arthritis. In the original work in this field it was recognized that there were certain inherent dangers in the method and that wide application would be permissible only with the greatest caution and under careful control.
When vaccines and other toxic protein substances are injected intravenously a train of reactions takes place that includes: (a) a primary leukopenia, followed by a leukocytosis; (b) a primary lessening of the coagulability of the blood, followed after some interval by a reduction of the coagulation time; (c) a pronounced lymphagogue effect, the flow of lymph from the thoracic duct being increased threefold; (d) a hyperperistalsis of the intestinal tract, and (e) a marked splanchnic engorgement with a resulting lowering of the systemic blood pressure. The alteration of the coagulability of the blood, together with the vascular engorgement of the splanchnic area and the coincident increase in motility of the intestinal tract that follow the therapeutic injection, all tend to increase the possibility of intestinal hemorrhage. Protein therapy is therefore not a safe procedure in this particular disease. That we are able to terminate a certain number of cases of typhoid fever by crisis by means of such injections is of very great interest from a theoretical point of view.
In the treatment of arthritis, the results seem much more satisfactory. The work of Miller andLusk296has been confirmed by a number of observers, among them Culver, Cecil, Snyder, Cowie and Calhoun; and there seems little doubt that we may be able to give prompt relief and even permanent freedom from symptoms in a considerable percentage of cases of acute and subacute arthritis, especially those classed as of rheumatic origin—and this with practically no risk to the patient.
As with other new therapeutic measures, there is still some uncertainty as to the proper dosage, which is a matter of considerable importance, in order to arrive at a just estimate of the relative advantage or danger in the treatment. Typhoid vaccines have been extensively used because they are readily procured and give a prompt and sharp reaction. However, they have the disadvantage of inexactitude in the bacterial count, as well as being of varying degrees of toxicity, the latter factor depending not only on the use of different strains of bacteria in their preparation but on the age of the vaccine. Synder,297as well as other workers, is of the opinion that the primary dose should be small—from five to ten million organisms—and that the dose of typhoid bacilli injected should never exceed two hundred and fifty million. While a sharp reaction on the part of the patient is apparently a desideratum, a sufficient response can usually be elicited with a relatively small dose. There is no object in subjecting the patient to the risk of the profound depression that follows occasionally in the wake of large doses. Indeed, the only serious results so far ascribed as due to this form of therapy have followed very large doses or the use of relatively large doses in moribund patients; or such unreasonable procedures as the intravenous injection of milk. It is true that milk injections were recommended by some of the German investigators, but they were always used intramuscularly.
In the treatment of pneumonia, Roberts andCary298have employed a vaccine made up of 100 million of each of the following organisms per cubic centimeter: influenza bacilli, pneumococci, staphylococci and streptococci. Of this vaccine they injected, intravenously, first 0.5 c.c., later 1 c.c. In the series of 200 patients so treated there was no evidence of injury to the patients in any way. The mortality in this series was 9.5 per cent.; in a series of eighty-six patients not treated with vaccine, the mortality was 31.2 per cent. In the untreated series, 20 per cent. recovered by crisis; in the treated, 36 per cent. so recovered. Before any reliance is placed on such statistics they should be analyzed and compared carefully according to age periods, as the death rate may vary at different ages. Cowie andBeaven298used typhoid vaccine in the treatment of their patients, and they consider the vaccine shock as indicated only in the early stages of pneumonia.
Before applying the treatment to such diseases as pneumonia it would seem that prudence would demand a thorough familiarity with the range of the reaction and the degree of toxicity of the preparation it is intended to use by first employing it in some arthritic cases. In pneumonia we must ever keep before us the vital factor of cardiac impairment; and certainly we must not undertake any measure that may depress the function of the heart. In arthritis this danger is largely a negligible one; and, with proper precaution, nonspecific therapy is not only without risk but indeed frequently followed by gratifying clinical improvement. Only in the light of experience gained in the manner indicated would it seem permissible for us to attempt to extend this form of therapy to more acute infections.—(Editorial from The Journal A. M. A., May 17, 1919.)
Within the past few weeks a number of inquiries have reachedThe Journalfrom physicians in Ohio, Indiana and Pennsylvania. Those that follow are typical:
“I am in receipt of literature from H. L. Roberts, 1126 Masonic Temple, Chicago, advertising clinic in Cleveland by Dr. Willard E. Ogden who claims to be a member of the Chicago Medical Society and the A. M. A. What can you say of this man and his methods?”“I am enclosing a folder received a short time ago. I would be glad to know if Dr. Ogden is a member of the A. M. A. as he claims to be.”“The enclosed folder has been sent to many doctors in Indiana. The purpose is plain. The attached post card on this one was returned to him for further literature.”
“I am in receipt of literature from H. L. Roberts, 1126 Masonic Temple, Chicago, advertising clinic in Cleveland by Dr. Willard E. Ogden who claims to be a member of the Chicago Medical Society and the A. M. A. What can you say of this man and his methods?”
“I am enclosing a folder received a short time ago. I would be glad to know if Dr. Ogden is a member of the A. M. A. as he claims to be.”
“The enclosed folder has been sent to many doctors in Indiana. The purpose is plain. The attached post card on this one was returned to him for further literature.”
Photographic reproduction of one of Ogden advertisements in Chicago newspapers at the time he was at 36 W. Randolph Street.
Photographic reproduction of one of Ogden advertisements in Chicago newspapers at the time he was at 36 W. Randolph Street.
In each case the correspondents send in a four-page folder bearing the title “Proctology, A Clinic. Who? Where? Why?” Three of the four pages purport to answer the interrogations given on the title page. Under “Who?” we read:
DR. WILLARD E. OGDENChicago, Ill.SPECIALIST IN PROCTOLOGYMember Chicago Medical Society and A. M. A.Author of “Improved Method of Treating Rectal Diseases”Formerly associated with Drs. Burleson & BurlesonGrand Rapids, Mich.
Under the question “Where?” there appears the statement that “Dr. Ogden Will Hold a Clinic for The Treatment of Rectal Diseases” and the name of the city and the dates of the “clinic” are inserted with a typewriter.
Under “Why?” we read:
“Dr. Ogden does not use the usual surgical methods. His many years of experience in the treatment of Rectal Diseases (during which time he has been associated with the leading Proctologists of America) have enabled him to develop a system of office treatmentwhich is not taught by any other practitioner.“Tear off, sign and mail attached postcard and I will send you a booklet giving you full particulars as to the course.Yours truly,H. L. Roberts, Business Manager.“Eighty-three per cent. of the people have some Rectal trouble. THIS IS THE DAY OF SPECIALISTS. Why not fit yourself to specialize in Proctology?”
“Dr. Ogden does not use the usual surgical methods. His many years of experience in the treatment of Rectal Diseases (during which time he has been associated with the leading Proctologists of America) have enabled him to develop a system of office treatmentwhich is not taught by any other practitioner.
“Tear off, sign and mail attached postcard and I will send you a booklet giving you full particulars as to the course.
Yours truly,
H. L. Roberts, Business Manager.
“Eighty-three per cent. of the people have some Rectal trouble. THIS IS THE DAY OF SPECIALISTS. Why not fit yourself to specialize in Proctology?”
The fourth page is a post card addressed to “H. L. Roberts, Room 1126, Masonic Temple, Chicago.” On the reverse side there is a printed statement which the recipient is expected to sign to the effect that he is interested in “Dr. Ogden’s Clinic” and wishes to have “full particulars of the course.”
A visit to Room 1126, Masonic Temple, failed to disclose the name of H. L. Roberts, either on the door (or doors, for there are two rooms having this number) or on the office building directory board. In fact, Rooms 1126 seem to contain a somewhat miscellaneous assortment. The signs, either on the door or on the directory board, show that there is a public stenographer (who operates a “Mailing Service,” and does “Addressing, Mailing, Multigraphing, Mimeographing”), a bookstore, a chocolate company, a publishing company, a lumber company, and one or two other concerns; but the name of “H. L. Roberts” does not appear. Incidentally, no “H. L. Roberts” is to be found listed in the Chicago telephone directory.
A few yards away from Rooms 1126 and on the same floor there appears the name, “Dr. Willard E. Ogden” on Room 1102.
According to our records, Willard Ealon Ogden was born in 1866. Before taking up the study of medicine he seems to have been a preacher. In 1899 he was graduated by the Saginaw Valley Medical College, Saginaw, Mich. He was licensed in Michigan in 1900, in Illinois and Indiana in 1913, and in Wisconsin in 1921. From 1900 until 1904 he practiced in Lyons, Mich.; from 1906 until 1911 he was at Ionia, Mich.
In 1911, he was in Grand Rapids, Mich., and was associated with Burleson and Burleson, an advertising pile cure concern. From some of the voluminous Burleson advertising on file, we learn that they “cure all diseases of the rectum (except cancer);” and claim to have “the most successful method ever discovered,” and to have cured “many desperate cases that have been given up to die.” Furthermore, they “guarantee to cure in every case or make no charge.”
On Jan. 1, 1914, Ogden was sending out a card to physicians in which he stated that he had removed from Grand Rapids, Mich., and LaPorte, Ind., to 36 W. Randolph St., Chicago, and that he would limit himself “exclusively to the treatment of diseases of the rectum.” Later, Ogden was sending out an advertising booklet filled with testimonials.
In 1914, Ogden was carrying display advertisements in Chicago papers reading, in part, in large back-faced type: “Piles Cured Absolutely Without Knife, Anesthetics, Pain or Loss of Time.... Cure Guaranteed or Money Refunded.”
In March, 1918, he became a member of the Chicago Medical Society and qualified for Fellowship in the American Medical Association, August, 1918.
In 1921, Ogden had a copyrighted mail-order course on the “Treatment of Rectal Diseases by Improved Method.” This “course” consisted of thirty-eight pages of foolscap printed on one side in imitation typewriting. The materialabounded in typographical errors. Among the proprietary products recommended in this “course” as “essential” to those taking it, was “Mecca Ointment.” This nostrum, made by a Chicago concern, was declared misbranded in 1916 because of false and fraudulent claims made knowingly, recklessly and wantonly. The “course” was divided into ten parts, and with it, apparently, came ten consecutively numbered sealed envelops, and the purchaser was instructed to open these envelops, one at a time, as he completed the corresponding part in the “course.” He would there find questions which were to be answered and returned to Ogden. This, according to the description, was to enable Ogden to determine whether it was necessary to “enter more into detail upon that particular subject,” which, he stated, he would gladly do if necessary.
Photographic reproduction (reduced) of the first page of a booklet Ogden was sending out in the latter part of 1914.
Photographic reproduction (reduced) of the first page of a booklet Ogden was sending out in the latter part of 1914.
Furthermore, the purchaser had the privilege of asking questions of Ogden relative to symptoms, diagnosis and treatment for a period of six months after the purchase of the “course.” Although, in Ogden’s opinion, “you should have the subject well understood long before that time.”
The charge for this course and “services as outlined” was $200, but in order to show his confidence in the ability of those who purchased it, Ogden was willing to take $100 down and the other $100 paid in “five per cent. of monies received fromCUREDpatients” until the balance was paid.
Reverting to the present “post-graduate course” and “clinic”: Those who send in the postal card to “H. L. Roberts” receive a form-letter, signed “H. L.Roberts” in facsimile handwriting, stating that information was enclosed “regardingTHE OGDEN METHODS” and stating that Dr. Ogden would be in Indianapolis or Cleveland or Pittsburgh, as the case might be, on a certain date and that the fee for the “clinic” would be $100. With this letter is an eight-page pamphlet entitled “Some Facts Concerning the Ogden Method of Treating Rectal Diseases.” The first page is headed in black-faced type: “About References and Endorsements.” It then states that the “usual references and endorsements are omitted from this booklet.” Further:
“As to Dr. Willard E. Ogden: The professional and social standing of Dr. Ogden is such that he does not need to offer any.“As to ‘THE OGDEN METHOD’ and its value to you in your professional work: What others say or think has little if any weight. You are your own man. You do your own thinking. You decide for yourself—Do you not?”
“As to Dr. Willard E. Ogden: The professional and social standing of Dr. Ogden is such that he does not need to offer any.
“As to ‘THE OGDEN METHOD’ and its value to you in your professional work: What others say or think has little if any weight. You are your own man. You do your own thinking. You decide for yourself—Do you not?”
Photographic reproduction (greatly reduced) of an advertisement of the Burleson concern with which Ogden was connected previous to 1914, and which connection he is capitalizing in his present advertising.
Photographic reproduction (greatly reduced) of an advertisement of the Burleson concern with which Ogden was connected previous to 1914, and which connection he is capitalizing in his present advertising.
The booklet gives an outline of the “Course of Instruction,” which is almost identical, word for word, with the outline given in the letter advertising the mail-order course previously referred to.
The booklet further states that “THE OGDEN METHODhas entirely eliminated the use of cautery, the ligature or any injections, in the treatment of hemorrhoids,”but that “the use of the electric current has proved to be the very correct method in such cases, as will be demonstrated at the clinic.” The booklet reiterates the statement that Ogden’s association with the Burleson and Burleson concern at Grand Rapids makes him “eminently well qualified to instruct members of the medical profession in this important branch of the medical science!”
In addition to this booklet there is a four-page advertising leaflet illustrating and describing the “Ogden Rectal Cabinet” and also the “Ogden Rectal Table and Stool.” There is also a little postcard—addressed, of course, to “H. L. Roberts”—for the physician to fill in stating that “you may enroll me as intending to attend Dr. Ogden’s Clinic in Proctology, to be held at——.” Should the recipient not fill in and mail this enrolment card he gets another form letter calling attention to the fact that the enrolment card has not been received and stating further that “available hotel facilities make it necessary to limit our enrolment to twenty students.”
Careful search fails to disclose that Dr. Willard Ealon Ogden has ever distinguished himself in the practice of the specialty in which he now wishes to instruct physicians. Equally careful search fails to show that Dr. Ogden has ever published a paper either on any proctologic subjects or on any other phase of medicine or surgery. Neither does there seem to be any evidence for the claim that Dr. Ogden “has been associated with the leading Proctologists of America.”—(From The Journal A. M. A., Feb. 4, 1922.)
The inequity of our patent laws, or possibly it would be more correct to say, of the interpretation of our patent laws, has been commented on many times inThe Journal.The Journalalso has had occasion to call attention to patents that have been issued for obviously unscientific and quackish devices and preparations. The cases of the preposterous gas-pipe fake “Oxydonor” and the creatinin mixture for the alleged conferring of immunity against diphtheria, pneumonia, scarlet fever, syphilis, tuberculosis, etc., are cases in point.
In a patent issued the early part of this year for the “discovery” of a method of flavoring Epsom salt, the patent office has, in fatuity, piled Pelion on Ossa. The “inventor” declares that his invention relates to a pharmaceutical preparation and a special method of treatment of the medicinal agents whereby said agent will be rendered much more efficient in character. He further avows that the “prime object” of his “invention” is to “disguise the normal taste and impart an agreeable odor or smell to salts commonly employed as a cathartic.” Parenthetically it may be said that probably not a day passes that some physician in the United States does not do substantially the same thing when writing a prescription. The “inventor” further claims that the object of his “invention” is to utilize the salts as a vehicle to carry an antiseptic and anesthetic agent whereby the salts when administered as a cathartic “will also act beneficially on the entire digestive tract” and “whereby cramped and spasmodic conditions are at once relieved with a resulting cure of flatulency, indigestion, sick and sour stomach, colic and the destruction of worms, etc.”
Such claims are so absurd that the only excuse for commenting on them is the effect they have on the public mind. The layman reading the specifications of this patent would naturally conclude that an invention of great importance had been made—of such importance as to warrant the government in rewarding its inventor by granting him a seventeen-year monopoly on the sale of his invention.
The law requires that, to be patentable, inventions shall be new and useful and shall show a higher degree of skill in their inception than is naturally to be expected from those who are skilled in the arts to which the inventions belong. It has been decided again and again that physicians’ prescriptions are not patentable because it is assumed that an educated physician will utilize his knowledge of pharmacy in devising proper compounds of medicines to meet the indications of disease. When a physician prescribes a dose of Epsom salt to be taken in one of the official aromatic waters, he does not produce or create a new invention by so doing. Of course, in one sense every prescription is an invention—an invention to meet the conditions presented by the patient—but such inventions are not patentable, because they represent the ordinary skill of a physician in carrying on his vocation.
If the patent office goes on granting patents for such “inventions” as flavored Epsom salt, and it should be found financially profitable to secure such patents and place the products on the market, it will only be a matter of time before the materia medica will be so restricted that a physician will be unable to write a prescription without infringing on somebody’s patent.
The splendid conception of the framers of our constitution in providing a plan for promoting progress in science and useful arts by granting to inventors for a limited time the exclusive use of their inventions, in exchange for the publication of full knowledge thereof, is being debased. No branch of our government is of greater importance to the progress of the country than the patent office, provided that office is intelligently administered. When the patent office is used, however, for an extention of the nostrum business, founded on the abuse of patent and trade-mark laws, it becomes a menace to the public health. The objects of the patent law are being defeated by the practices of the patent office.—(Editorial from The Journal A. M. A., June 23, 1917.)
In this issue we publish two reports of the Council on Pharmacy and Chemistry which illustrate the weaknesses of the present working of the United States patent laws. In the first report the Council presents an investigation of a recently granted patent, and shows that the patent was issued on the mere claims of the applicant and without the presentation of any evidence for such claims. The second report—“Need for Patent Law Revision”—is an appeal to the Patent Office for a more enlightened administration of the patent law, and it presents a few illustrations of the unfair protection which has been granted by the Patent Office. The protest of the Council appears at an opportune time. InScience299the “Patent Office Society,”an association of employees of the U. S. Patent Office, announces that a committee has been created on request of the National Research Council to make a study of the U. S. Patent Office and its service to science and arts. It states that this committee will meet in Washington shortly to consider the adequacy of the present Patent Office equipment and the simplification of procedure as well as responsiveness to present national and international requirements. The committee also hopes to coordinate, in the interest of an improved public service, the endeavors of the various national societies, manufacturing interests, patent bar associations and all others aiming at genuine patent reform. Unquestionably, there is a growing conviction that in the case of medicines the monopoly given by the patent laws, if granted at all, should be granted with greater consideration of the public welfare. Too often the United States Patent Law has been used to obtain an unfair monopoly on a medicament or to abet quackery. There is no question that one of two things is needed: either a radical change in the patent law itself or the application of more brains in its administration.—(Editorial from The Journal A. M. A., Jan. 12, 1918.)
The patent onaspirin300(acetylsalicylic acid), controlled by the Bayer Company, American representative of the Farbenfabriken of Elberfeld Company, will expire next year (1917).The Journalhas previously stated that the grant of this patent was regrettable and worked injustice to American citizens. It is unnecessary again to go into the grounds for this statement; neither in the Farbenfabriken’s home country, Germany, nor in any other country except in the United States, has a patent been granted for this product. Owing to their monopoly, the manufacturers have been able to exact a much higher price for acetylsalicylic acid, or aspirin, in this country, than elsewhere. Naturally, the Bayer Company, the American agents, view with disfavor the prospect of being compelled to share this rich field with competitors. The foregoing furnishes the answer to inquiries which have reached us from all over the country with regard to the campaign of publicity which the Bayer Company has inaugurated in the lay press. A presumably authentic and apparently candid exposition of the methods used and the motives behind the aspirin advertising is furnished inPrinters’ Ink:301
“The manufacturers of aspirin are about to launch an extensive advertising campaign to clinch the market as far as possible before the expiration of their patent rights next year.... The purpose of the campaign is to identify the product with the trademark of the Bayer Company and to this extent hamper competition after the expiration of the patent.”
“The manufacturers of aspirin are about to launch an extensive advertising campaign to clinch the market as far as possible before the expiration of their patent rights next year.... The purpose of the campaign is to identify the product with the trademark of the Bayer Company and to this extent hamper competition after the expiration of the patent.”
The business of the Bayer Company, the article goes on to say, has been hurt by the sale of worthless or even harmful imitations put on the market by irresponsible and unauthorized persons when the present war stopped importations from Germany.
“The public knew aspirin, but did not know who made it [italics ours].... When the Bayer Company, Inc., took over the manufacture of aspirin in this country, the first steps were taken to identify the product with the firm who made it.... Of course, there are good reasons why the makers were loth to advertise the product or to exploit their trademark. As every one knows, the advertising of a medical proposition is an extremely ticklish subject.... It is easy to make a misstep. Aspirin is one of those proprietary drugs that are extensively prescribed by physicians. If anything were done that might possibly associate this drug with the patent medicines that are in disfavor with the profession, the valuable influence and cooperation of thousands of doctors might be lost. It is believed that this knotty phase of the question is being answered in the present advertising.... Since nothing is mentioned about ‘medicine,’ ‘cures’ or ‘ailments,’ it is anticipated that there will be but little objection to the copy. All that the advertising attempts to do is to link up the name ‘Bayer’ with aspirin.... The nearest the copy gets to medical talk is in this sentence in very small type at the bottom of the advertisement, ‘The trademark “Aspirin” (Reg. U. S. Patent Office) is a guarantee that the monoacetic acid ester of salicylic acid in these tablets is of the reliable Bayer manufacture.’ ”
“The public knew aspirin, but did not know who made it [italics ours].... When the Bayer Company, Inc., took over the manufacture of aspirin in this country, the first steps were taken to identify the product with the firm who made it.... Of course, there are good reasons why the makers were loth to advertise the product or to exploit their trademark. As every one knows, the advertising of a medical proposition is an extremely ticklish subject.... It is easy to make a misstep. Aspirin is one of those proprietary drugs that are extensively prescribed by physicians. If anything were done that might possibly associate this drug with the patent medicines that are in disfavor with the profession, the valuable influence and cooperation of thousands of doctors might be lost. It is believed that this knotty phase of the question is being answered in the present advertising.... Since nothing is mentioned about ‘medicine,’ ‘cures’ or ‘ailments,’ it is anticipated that there will be but little objection to the copy. All that the advertising attempts to do is to link up the name ‘Bayer’ with aspirin.... The nearest the copy gets to medical talk is in this sentence in very small type at the bottom of the advertisement, ‘The trademark “Aspirin” (Reg. U. S. Patent Office) is a guarantee that the monoacetic acid ester of salicylic acid in these tablets is of the reliable Bayer manufacture.’ ”
From this it appears that, not content with seventeen years of monopoly, the aspirin people are attempting to retain a hold on the marketin perpetuoby associating the name of the company with the trade name “aspirin.” There can be no better time than the present, therefore, for the medical profession to substitute, for the nondescriptive name “aspirin,” the descriptive and correct name acetylsalicylic acid.—(Editorial from The Journal A. M. A., Aug. 12, 1916.)
In the past, therapeutic agents and apparatus have been controlled by patents and trademarks for profit. If there have been exceptions, they have been rare. The Principles of Medical Ethics of the American Medical Association contain this statement: “It is unprofessional to receive remunerationfrom patents for surgical instruments or medicines.” This does not mean that the patenting is wrong in itself; there are occasions when it is wise, if not necessary, to obtain a patent in the interest of the public, and, in the case of surgical instruments and medicines, of the medical profession. In certain instances it is absolutely necessary that the article produced shall maintain a definite standard of quality and purity—and, it may be added, shall be sold at a reasonable price. Enterprising pharmaceutical manufacturers have usually been ready to appropriate the results of scientific research by investigators or therapeutic measures suggested by practicing physicians. Not infrequently, in such instances, the desire for financial gain has caused the marketing of such products with extravagant, if not false, claims as to their value. Yet the patent laws may be used so as to protect and benefit the public and the medical profession. In research laboratories, work is being carried on resulting in the production of new therapeutic agents. It is important that these agents shall be so controlled that they may be made available without subordination to commercial interests. It has become practically necessary, therefore, for research workers to protect their products in the interest of the public welfare and scientific medicine. It has not been an easy matter to decide how best to bring about the desired results. This question has been before the Board of Trustees of the American Medical Association; and, in 1914, the House of Delegates passed a resolution authorizing the board to accept at its discretion patents for medical and surgical instruments and appliances; as trustees, for the benefit of the profession and the public, provided that neither the Association nor the patentee should receive remuneration from these patents. The Rockefeller Institute for Medical Research has solved the problem in a similar manner. In connection with the report of the discovery of several new arsenic compounds, Jacobs and Heidelberger,302working in the Rockefeller Institute, say:
It may be appropriate to mention here that this substance and related compounds, described in the present and following papers of the series, are covered by U. S. Patents Nos. 1280119-27. Patents have also been applied for in foreign countries. All discoveries made at the Rockefeller Institute are made freely available to the public, in accordance with the philanthropic purposes of the institution. In order to insure purity of product and protection against exploitation, it has been deemed necessary in certain instances to protect the discoveries by patents. It is the purpose of the institute to permit any drugs which may prove of practical therapeutic value to be manufactured under license by suitable chemical firms and under conditions of production which will insure the biological qualities of the drugs and their marketing at reasonable prices. Other than through the issuance of license, the Rockefeller Institute does not participate in any way in the commercial preparation or sale of the manufactured chemicals; and it receives no royalties or other pecuniary benefits from the licenses it issues.
It may be appropriate to mention here that this substance and related compounds, described in the present and following papers of the series, are covered by U. S. Patents Nos. 1280119-27. Patents have also been applied for in foreign countries. All discoveries made at the Rockefeller Institute are made freely available to the public, in accordance with the philanthropic purposes of the institution. In order to insure purity of product and protection against exploitation, it has been deemed necessary in certain instances to protect the discoveries by patents. It is the purpose of the institute to permit any drugs which may prove of practical therapeutic value to be manufactured under license by suitable chemical firms and under conditions of production which will insure the biological qualities of the drugs and their marketing at reasonable prices. Other than through the issuance of license, the Rockefeller Institute does not participate in any way in the commercial preparation or sale of the manufactured chemicals; and it receives no royalties or other pecuniary benefits from the licenses it issues.
Here we have medicine at its best. The altruism of pure science operating for the benefit of the general public: scientific therapeutics freed from commercial domination.—(Editorial from The Journal A. M. A., Oct. 18, 1919.)
Does the public love to be humbugged? We doubt it. That we, whether sage or fool,arehumbugged is undeniable. We are humbugged just to the extent that we are ignorant. There lies one of the most powerful factors operating to the advantage of the “patent medicine” maker and the quack. The layman’s ignorance of the possibilities and limitations of drugs is wide and deep. Hence the ease with which he is fooled on this subject. A seeming frankness in advertising being the order of the day, the nostrum maker makes a pretense of telling what is in his stuff without disclosing any facts that will tend tolift the veil of mystery and thus destroy his greatest asset. So the exploiter of nostrums to the medical profession, realizing that at least a pretense must be made of giving the composition of medicaments offered to the physician, declares that his clay poultice has for its base “anhydrous and levigated argillaceous mineral.” This sounds much more imposing than dry and finely powdered clay, and satisfies by its very sonorousness. Now comes a product exploited chiefly to members of the dental profession but also, it seems, to physicians. Tablets, “activated tablets,” if you please! They are “an anodyne, analgesic febrifuge sedative, exorcising [sic!] antineuralgic and antirheumatic action.” And their composition? Simply “an activated, balanced combination of the mono-acetyl-derivative of para-amidophenetol together with a feebly basic substance in the alkaloidal state from the Thea-Sinensis.” As clear as the Missouri River! Some day some dentist or physician is going to investigate and find that this awe-inspiring, polysyllabic example of exuberant verbosity means nothing more mysterious than our old friends acetphenetidin (phenacetin) and caffein. In the meantime, the exploiters may smile softly and murmur, “Barnum was right!”—(Editorial from The Journal A. M. A., Jan. 1, 1921.)
The ninth revision of the United States Pharmacopeia became official this week, Sept. 1, 1916. It is more fully reviewed elsewhere;303here we desire merely to call attention to two points; what the book is and what it is not. It is a book of standards for drugs; it is not a book of standard remedies. The Committee of Revision of the Pharmacopeia included physicians and pharmacists (retail, wholesale and manufacturing), but the pharmacists were in the majority and in control. The majority of the representatives of the medical profession on this committee would have preferred to see the bulk of the Pharmacopeia reduced and its value as a work of reference enhanced by the rejection of therapeutically worthless drugs. The representatives of commercial interests, on the other hand, argued that it was necessary for the Pharmacopeia to provide standards for drugs in more or less general use, whether worthless or otherwise. The force of this argument is somewhat impaired by the fact that the National Formulary, which has also been made a book of legal standards, now includes individual drugs as well as combinations; the new edition of the Formulary, in fact, contains a large number of drugs which had been dropped from the U. S. Pharmacopeia VIII. The principle of making use the sole criterion for admission to the Pharmacopeia, however, on the whole carried the day. It has not been strictly observed; good results from the efforts of the medical contingent are to be observed here and there, as in the deletion of elixir of the phosphates of iron, quinin and strychnin and of emulsion of cod liver oil with hypophosphites. That these instances were not expressions of policy on the part of the Committee on Revision, but merely deviations from policy, may be seen by a glance at the contents of the new Pharmacopeia. These include substances which have been shown to be inert, like the hypophosphites (calcium, potassium and sodium hypophosphites), complex and obsolete mixtures, like the compound syrup of sarsaparilla, and drugs which have been tried and found wanting, like saw palmetto berries. Even substances seldom used by the medical profession, but chiefly or altogether by the public, like sassafras, hops and peppermint (the herb), are standardized and made official. It seems difficult to discover any principle by which the sphere of the Pharmacopeia may be definitely marked off from that of theNational Formulary. There is one great advantage in specifying U. S. P. drugs and preparations: Physicians who do so invoke legal standards of purity and identity. The only way to be sure of obtaining substances of therapeutic efficiency, however, is to exercise discrimination. The Pharmacopeia is no guide. Being prepared mainly by pharmacists to meet the needs of pharmacists, the Pharmacopeia of course contains much matter of little interest to physicians and entirely foreign to scientific medicine.—(Editorial from The Journal A. M. A., Sept. 2, 1916.)
The ninth revision of the United States Pharmacopeia, which has been in the hands of the Committee of Revision for more than six years, has just appeared. As was to be expected, the desire of medical men on the Committee of Revision to have therapeutic value made a requirement for admission to the Pharmacopeia has not been fully realized; it remains a book of standards for therapeutically good, bad and indifferent remedies. Among the drugs of little or no therapeutic importance or value are musk, arnica, eriodictyon, quassia, pumpkin seed, saw palmetto berries, sarsaparilla and couch grass. Many superfluous drugs and preparations are included. For instance, of the nine forms of quinin described (quinin alkaloid, bisulphate, dihydrochlorid, hydrobromid, hydrochlorid, salicylate, sulphate and tannate, and quinin and urea hydrochlorid), at least four might well have been eliminated. Two insoluble forms (the alkaloid and the tannate), two soluble forms (the hydrochlorid and quinin and urea hydrochlorid), and a moderately soluble form (the sulphate) are all that could reasonably be demanded by even the most extreme partisans of the doctrine of “pharmaceutic necessity.” Further, the use of quinin salicylate for its salicylic acid content and of quinin hydrobromid for its bromid content is unscientific. The inclusion of these salts in the Pharmacopeia is regrettable.
Those interested in the promotion of rational therapy will also regret the inclusion of a number of fluidextracts of violently toxic drugs, such as aconite and gelsemium (dose1⁄2minim each), belladonna root, digitalis, nux vomica and ipecac (dose 1 minim each), and lobelia (dose 21⁄2minims). The more diluted forms, the tinctures, of these drugs are preferable. The inclusion of such fluidextracts in the Pharmacopeia is playing into the hands of certain pharmaceutical manufacturers, who recommend the tincture be prepared from fluidextracts—an unscientific procedure.
The efforts of the medical members of the committee, however, have not been entirely fruitless. Of the articles described in the U. S. Pharmacopeia VIII, 243 have been deleted; sixty-seven new articles have been added. The loss of 167 titles may be set down as a gain. Moreover, most of the new substances give promise of therapeutic usefulness. Thirty-six are taken over from New and Nonofficial Remedies; nineteen are substances which are in the edition of Useful Drugs now in the press. It cannot be said, however; that all of the additions have been judiciously selected. It is an infelicitous time to add calcium and sodium glycerophosphate just when grave doubts of their therapeutic efficiency are being felt. The addition of the extracts of aconite, hydrastis and viburnum prunifolium is likewise unfortunate. All are superfluous preparations, the first because a drug so powerful that an average dose of the extract is only 10 mg. or1⁄6grain is better given in the form of tincture; the second because hydrastis is a drug of uncertain value, already represented by three preparations, and the third because viburnum prunifolium has been discarded and discredited by the best therapeutic authorities. It must be accounted clear gain, on the other hand, that the deletions include many inert, obsolete or superfluous substances like bismuth citrate, kaolin cataplasm, pipsissewa, cocaleaves, ladyslipper, wahoo, cotton root bark, compound acetanilid powder and compound syrup of hypophosphites, not to mention nine salts of iron and thirty-eight fluidextracts of various drugs. Wines, unmedicated and medicated, whisky and brandy are also among the articles dropped.
A number of new features are introduced, such as microscopic standards for powdered drugs, standard abbreviations for titles, the use of the term “mil” instead of “cubic centimeter,” and a chapter each on sterilization, diagnostic reagents, biologic assays, electrolytic determination of metals and the determination of alcohol, the melting point, the boiling point and the congealing point.
The chemical nomenclature is substantially the same as that adopted in the previous revision; so is the nomenclature of drugs. The addition of official abbreviations for the Latin titles of drugs will doubtless be found a useful feature.
Less commendable is the change from the familiar “Cc.” to “mil.” The term “cubic centimeter” is so thoroughly established and so widely used, wherever the metric system is employed, that it cannot be expected that it will be universally displaced by the word “mil.” The latter is therefore only a superfluous synonym, and as such out of harmony with the simplicity of the metric system. Perhaps it may even be taken for the abbreviation of “millimeter,” “milligram” or other words derived from “mille,” which would be equally entitled to the same abbreviation.—(Book Review in The Journal A. M. A., Sept. 2, 1916.)
The letter that follows comes from a physician who feels that he has a grievance regarding a company in which he holds stock:
“In 1914, I bought some stock of the —— —— Company, and in 1917 bought some more stock in the same company. I notice that the company advertises inThe Journal of the American Medical Association, and I believe it does this not so much to acquaint the medical profession with its product, as to acquaint physicians with its name in order that its stock salesmen can keep on unloading more stock to members of the medical profession.“The company gets the doctors’ money through the sale of stocks, it gets its product on the market with the doctors’ assistance and through their influence, and it looks to me as if the doctors were getting very little in return, as the dividend checks have been few and far between since I have known anything of the company.“It is not my idea to criticize the product; but I do believe and feel that the stockholders are entitled to a square deal from a company which in turn is expecting so much from them, and again I feel that the publishers ofThe Journalshould be made aware of these conditions so that they do not either consciously or unconsciously foster a concern that is depriving the physician of his hard-earned money.“If this letter is unfair, I am willing to be shown otherwise. Kindly publish it inThe Journal, omitting my name and address.”
“In 1914, I bought some stock of the —— —— Company, and in 1917 bought some more stock in the same company. I notice that the company advertises inThe Journal of the American Medical Association, and I believe it does this not so much to acquaint the medical profession with its product, as to acquaint physicians with its name in order that its stock salesmen can keep on unloading more stock to members of the medical profession.
“The company gets the doctors’ money through the sale of stocks, it gets its product on the market with the doctors’ assistance and through their influence, and it looks to me as if the doctors were getting very little in return, as the dividend checks have been few and far between since I have known anything of the company.
“It is not my idea to criticize the product; but I do believe and feel that the stockholders are entitled to a square deal from a company which in turn is expecting so much from them, and again I feel that the publishers ofThe Journalshould be made aware of these conditions so that they do not either consciously or unconsciously foster a concern that is depriving the physician of his hard-earned money.
“If this letter is unfair, I am willing to be shown otherwise. Kindly publish it inThe Journal, omitting my name and address.”
The company to which our correspondent refers put out a proprietary product prescribed by physicians and used by the public. Some years ago the company in question advertised its product inThe Journaluntil its stock-selling scheme was brought to the attention ofThe Journal; the advertisements were then rejected. Some years later, on evidence that the company had discontinued its stock-selling methods to physicians, its product was again admitted to the advertising pages ofThe Journal. Our correspondent says that he believes that the physicians who hold stock in this company “are entitledto a square deal.” What about the public? Is it getting a square deal when physicians are financially interested in the products that they may be called on to prescribe? Is the average layman’s confidence in the medical profession likely to be enhanced when he learns that the physician to whom he went for treatment has a financial interest in the therapeutic agent which was prescribed? Our correspondent’s complaint against the company seems to be, not that the company sold stock to physicians, but that “the dividend checks have been few and far between,” the assumption being that had the dividends come regularly, there would have been no complaint. It cannot be too often emphasized that it is against public interest and scientific medicine for physicians to be financially interested in the sale of products which they may be called on to prescribe for the sick. It is perfectly true that there are many physicians who would not consciously permit financial considerations to warp their judgment; but it is not humanly possible to remain unbiased in cases of this sort. It is conceivable that a judge on the bench might make every effort to dispense impartial justice in a suit in which one of the parties was a firm in which he, the judge, had financial interest. Nevertheless, it would be obviously improper for such a judge to try a case of this kind. Yet, in this supposititious case the only harm that could result would be of a financial nature. In the case of the physician, the harm is not to the public’s purse but to the public’s health.—(From The Journal A. M. A., Dec. 11, 1920.)
The importance of the standardization of preparations of the posterior, or infundibular, lobe of the pituitary gland (the liquor hypophysis of the new United States Pharmacopeia, pituitary solution, pituitary extract, etc.) is exemplified by a recent publication of Roth.304As is well known, the active constituent or constituents of this gland have not been isolated, and there is no chemical method of determining the activity and therapeutic value of various preparations. There are, however, certain physiologic methods by which the activity of such preparations may be determined with a considerable degree of exactness. The last revision of the Pharmacopeia, recognizing that the best attested field of usefulness for such preparations is in obstetrics, adopted as a test their activity on the uterus of the guinea-pig; the details of the method adopted by the Pharmacopeia are those described by Roth.305Roth now reports on the activity of seven samples of commercial infundibular extracts, the products of five American manufacturing pharmacists. Four of these samples were found to be of Pharmacopeia strength; the other three were much weaker. Of the latter, one had but one tenth, another but one fifth and the third but one fourth of the required activity. Those preparations which had been accepted by the Council on Pharmacy and Chemistry for inclusion in New and Non-official Remedies corresponded to the Pharmacopeia requirements. Roth also compared the activity of these seven preparations on the blood pressure, another method by which it has been proposed to standardize infundibular extracts. The four preparations which were equally active on the uterus were found to be equally active on the blood pressure; the other three were much weaker. Roth points out, however, that the results of the two methods are not necessarily parallel; in one instance, for example, two samples caused equal rises of blood pressure, but one was twice as active as the other on the uterus. Hence it is evident that the blood pressure test is not a satisfactory method for determining the activity of a preparation on the uterus, and vice versa.
The subject of pituitary standardization, or perhaps it may be said the application of the present method is, however, in need of further study. Thus the statement has recently beenmade306that commercial preparations are on the market which have from three to five times the activity of the Pharmacopeia standard; this was not the case, however, with the preparations examined by Roth. It is probable that some have used for comparison a weaker standard than that proposed by the Pharmacopeia; this, of course, would lead to the conclusion that the commercial preparations were stronger than the Pharmacopeia standard. Roth suggests that the employment of standards of unequal activity by the various supply houses could easily be eliminated by having a central laboratory distribute material for use as a standard. It will be recalled that before the United States Public Health Service established and began the distribution of standards for diphtheria and tetanus antitoxins, the commercial preparations of these varied even more in activity than do those of the pituitary extracts at present.
It is unnecessary to emphasize the importance of this subject; this is sufficiently evident to those who have followed the recent clinical literature on the use of pituitary extracts in obstetrics. These preparations are used in times of emergency; a weak preparation is valueless, whereas overdosage, either from too strong a preparation or from too free use of a preparation of the official strength, is often followed by disaster to the mother or child or both. Roth cites a number of cases of ruptured uterus and other injuries resulting from their use.—(Editorial from The Journal A. M. A., May 5, 1917.)
To the Editor:—I am enclosing a reprint of my article on the “Present Status of Pituitary Extract in Labor,” which appeared inThe Journal, June 2, 1917, p. 1601, and also the September issue of Parke, Davis and Company’sTherapeutic Notes, on page 89 of which they quote this article, that you may compare the two. TheTherapeutic Notesarticle is ostensibly a copy, but as a matter of fact, it gives it only in part, which seems to me to be a gross misrepresentation, and one which I do not think should go unnoticed.
Joseph J. Mundell, M.D., Anacostia, D. C.
[Comment.—Therapeutic Notesis one of the house organs of Parke, Davis and Company. A part of each issue is usually devoted to “excerpts” from current literature. TheTherapeutic Notesmay be judged from the manner of “excerpting” the article of Dr. Mundell. Naturally the interest of Parke, Davis and Company is in those sections of the article which may be expected to promote the use of Parke, Davis and Company’s proprietary preparation of pituitary extract—pituitrin. The following passages from the article of Dr. Mundell were not among those “excerpted” inTherapeutic Notes: