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ADVERTISEMENTS FOR DRUGS
1156
Letters to the Editor ADVERTISEMENTS FOR DRUGS
SiR,-At present the ethical pharmaceutical industry is under fire from a small but vociferous number of doctors who criticise the method and manner of advertising, the visits of representatives, and the " insidious " publication of the " inspired " article. No reasonable man shrinks from fair criticism, and in this instance most pharmaceutical manufacturers will welcome it, for they are eager to improve methods of informing the profession about their products, and to eliminate waste in doing this. But it is to be regretted that some at least of the critics of pharmaceutical promotion seem perhaps to have allowed a political prejudice against If this all private enterprise to tinge their opinion. it to see how is is difficult they suggestion unjustified, can disregard the fact that the greater part of modern therapeutic advance has been made in the laboratories of commercial houses, and by outside " academic and " outside " clinical workers supported by the pharmaceutical companies. Further, all the major firms have not only one or more full-time medical men on their staff, but retain as advisers a large number of professors and consultants among whom are many of the leading members of our profession-one in which integrity has always been prized as a prime virtue. These attacks are also directed, by implication at least, towards all medical brethren who pay any attention to the commercial promotion of new drugs, who use their knowledge and experience to separate the wheat from the chaff, before prescribing such remedies even though these have not yet qualified for the British Pharmacopmia. Drugs are not included in this and other standard volumes until an extensive experience has been gained in their use, and such experience could hardly be obtained without clinical and laboratory work. It may well be asked how this is to be done without cooperation between the manufacturer and the medical profession. No-one would deny that some of the therapeutic novelties have little to recommend them, and that some advertising outruns the licence normally accorded to this inescapable necessity of modern times-even nationalised industries advertise. But when a large and progressive industry, which has made a specially valuable contribution to export, is condemned because its tail end drags in the dust one may point out that it is a common fallacy of inductive reasoning to apply without evidence to the whole what is true of only a small part. So much of this is so familiar to the great majority of your readers that I feel some apology is due for taking I have sought the so much of your valuable space. hospitality of your columns not so much because medical men need to have these facts pointed out to them, but because such adverse criticism has been applied by the lay press and in political circles not only to blacken the industry, but, both by implication and directly, to attack the medical profession as a whole. W. P. KENNEDY The Distillers Co. (Biochemicals) Ltd., "
London, W.1.
Chief Medical Adviser.
SIR,-An unusual
and dangerous method of advertising to my notice. Everyone is familiar with the street canvasser of coupons
has
come
for soap flakes, &c. Recently such a person passed from door to door up the road where I live giving away free samples of aspirin tablets. In our own case the doorbell was rung but before the door could be answered the samples were being Conversation with the pushed through the letter-box. canvasser showed that each family was to receive six gr. 5 aspirin tablets. Their only covering was a little tinfoil which any child could undo in a moment. They were accompanied by a pamphlet suggesting that the tablets would relieve
colds, influenza, and various
insomnia in addition to
pain
due to
causes.
One is disturbed at the lengths to which this method of advertisement for drugs might be carried. Correspondence with the firm elicited a somewhat’ unsatisfactory reply and showed that they were unconcerned with the ethics of handing out drugs free as an advertisement. In fact at first they were put out at the unfairness of there being no plate on my door to warn the canvasser! N. F. COGHILL. London. W.5. HYPOTHYROIDISM AFTER THYROIDECTOMY
SiR,-May I elaborate, somewhat belatedly, the letter of Dr. Deborah Doniach in your issue of Sept. 1’!z? In this letter she pointed out that in Dr. Baron’s series half the cases of postoperative hypothyroidism (excluding that intentionally induced) occurred in patients with Hashimoto’s disease. She added that in a survey at the Middlesex Hospital 30 out of 31 patients with Hashimoto’s disease became hypothyroid after operation, whereas hypothyroidism is " relatively uncommon" after operation for other types of goitre. Of course, the incidence of hypothyroidism must depend to a certain extent upon the surgeon’s habit. It has been shown that a surgeon who increases the amount of gland he habitually removes increases the proportion of patients developing postoperative hypothyroidism and decreases the recurrence-rate. But the change in the figures is not likely to be great, presumably because any healthy thyroid tissue left behind is stimulated to hypertrophy by the anterior pituitary. In Hashimoto’s disease this does not occur-a fact which is well recognised. What is less well recognised is the high incidence of hypothyroidism after the removal of thyroids containing lesser amounts of lymphadenoid tissue. In a survey at New End Hospital122 it was found that, whereas 100% of patients with Hashimoto’s disease developed hypothyroidism, this result followed also in 83% of patients with severe lymphadenoid changes short of Hashimoto’s disease, 38% of patients with mild lymphadenoid changes, and only 0-3% of patients in whom no lymphadenoid change seemed to have occurred. RAYMOND GREENE. London, W.l. "
ERADICATION OF TUBERCULOSIS on behalf of the Tuberculosis Society, Metropolitan Regional present (Nov. 17) a number of interesting methods for the attack on tuberculosis, all of which should be executed in the next two years. However, unless greater emphasis is laid on the preventive aspect, and greater dynamic put into the whole drive -against this disease, not only will the public continue to accept it as one of the scourges of civilisation but the chest services will be long occupied in dealing with a preventabledisease instead of making further strides in the attack on the other two major problems-chronic bronchitis and carcinoma. If the propaganda that has been directed to vaccination against poliomyelitis, a disease with an incidence and a killing power much below that of tuberculosis, had been used for B.C.G. vaccination and to stress the advantages of treatment and the fact that the disease is curable and preventable, a great step forward would have been made. There is a considerable danger that the publicity attaching to poliomyelitis may force the problems of tuberculosis out of the public’s attention and also from the attention of the medical profession. There should be a shift of emphasis in the mass X-ray drive to make full use of all the voluntary services of a
SiR,-Dr. Pugh and Dr. Jeanes,
South-East
community. 1. Greene, R. 2. Greene, R.
J. Endocrin. 1950, 7, 1. In Memoirs of the Society for London, 1953; vol. 1, p. 16.
Endocrinology.
Letters to the Editor ADVERTISEMENTS FOR DRUGS
SiR,-At present the ethical pharmaceutical industry is under fire from a small but vociferous number of doctors who criticise the method and manner of advertising, the visits of representatives, and the " insidious " publication of the " inspired " article. No reasonable man shrinks from fair criticism, and in this instance most pharmaceutical manufacturers will welcome it, for they are eager to improve methods of informing the profession about their products, and to eliminate waste in doing this. But it is to be regretted that some at least of the critics of pharmaceutical promotion seem perhaps to have allowed a political prejudice against If this all private enterprise to tinge their opinion. it to see how is is difficult they suggestion unjustified, can disregard the fact that the greater part of modern therapeutic advance has been made in the laboratories of commercial houses, and by outside " academic and " outside " clinical workers supported by the pharmaceutical companies. Further, all the major firms have not only one or more full-time medical men on their staff, but retain as advisers a large number of professors and consultants among whom are many of the leading members of our profession-one in which integrity has always been prized as a prime virtue. These attacks are also directed, by implication at least, towards all medical brethren who pay any attention to the commercial promotion of new drugs, who use their knowledge and experience to separate the wheat from the chaff, before prescribing such remedies even though these have not yet qualified for the British Pharmacopmia. Drugs are not included in this and other standard volumes until an extensive experience has been gained in their use, and such experience could hardly be obtained without clinical and laboratory work. It may well be asked how this is to be done without cooperation between the manufacturer and the medical profession. No-one would deny that some of the therapeutic novelties have little to recommend them, and that some advertising outruns the licence normally accorded to this inescapable necessity of modern times-even nationalised industries advertise. But when a large and progressive industry, which has made a specially valuable contribution to export, is condemned because its tail end drags in the dust one may point out that it is a common fallacy of inductive reasoning to apply without evidence to the whole what is true of only a small part. So much of this is so familiar to the great majority of your readers that I feel some apology is due for taking I have sought the so much of your valuable space. hospitality of your columns not so much because medical men need to have these facts pointed out to them, but because such adverse criticism has been applied by the lay press and in political circles not only to blacken the industry, but, both by implication and directly, to attack the medical profession as a whole. W. P. KENNEDY The Distillers Co. (Biochemicals) Ltd., "
London, W.1.
Chief Medical Adviser.
SIR,-An unusual
and dangerous method of advertising to my notice. Everyone is familiar with the street canvasser of coupons
has
come
for soap flakes, &c. Recently such a person passed from door to door up the road where I live giving away free samples of aspirin tablets. In our own case the doorbell was rung but before the door could be answered the samples were being Conversation with the pushed through the letter-box. canvasser showed that each family was to receive six gr. 5 aspirin tablets. Their only covering was a little tinfoil which any child could undo in a moment. They were accompanied by a pamphlet suggesting that the tablets would relieve
colds, influenza, and various
insomnia in addition to
pain
due to
causes.
One is disturbed at the lengths to which this method of advertisement for drugs might be carried. Correspondence with the firm elicited a somewhat’ unsatisfactory reply and showed that they were unconcerned with the ethics of handing out drugs free as an advertisement. In fact at first they were put out at the unfairness of there being no plate on my door to warn the canvasser! N. F. COGHILL. London. W.5. HYPOTHYROIDISM AFTER THYROIDECTOMY
SiR,-May I elaborate, somewhat belatedly, the letter of Dr. Deborah Doniach in your issue of Sept. 1’!z? In this letter she pointed out that in Dr. Baron’s series half the cases of postoperative hypothyroidism (excluding that intentionally induced) occurred in patients with Hashimoto’s disease. She added that in a survey at the Middlesex Hospital 30 out of 31 patients with Hashimoto’s disease became hypothyroid after operation, whereas hypothyroidism is " relatively uncommon" after operation for other types of goitre. Of course, the incidence of hypothyroidism must depend to a certain extent upon the surgeon’s habit. It has been shown that a surgeon who increases the amount of gland he habitually removes increases the proportion of patients developing postoperative hypothyroidism and decreases the recurrence-rate. But the change in the figures is not likely to be great, presumably because any healthy thyroid tissue left behind is stimulated to hypertrophy by the anterior pituitary. In Hashimoto’s disease this does not occur-a fact which is well recognised. What is less well recognised is the high incidence of hypothyroidism after the removal of thyroids containing lesser amounts of lymphadenoid tissue. In a survey at New End Hospital122 it was found that, whereas 100% of patients with Hashimoto’s disease developed hypothyroidism, this result followed also in 83% of patients with severe lymphadenoid changes short of Hashimoto’s disease, 38% of patients with mild lymphadenoid changes, and only 0-3% of patients in whom no lymphadenoid change seemed to have occurred. RAYMOND GREENE. London, W.l. "
ERADICATION OF TUBERCULOSIS on behalf of the Tuberculosis Society, Metropolitan Regional present (Nov. 17) a number of interesting methods for the attack on tuberculosis, all of which should be executed in the next two years. However, unless greater emphasis is laid on the preventive aspect, and greater dynamic put into the whole drive -against this disease, not only will the public continue to accept it as one of the scourges of civilisation but the chest services will be long occupied in dealing with a preventabledisease instead of making further strides in the attack on the other two major problems-chronic bronchitis and carcinoma. If the propaganda that has been directed to vaccination against poliomyelitis, a disease with an incidence and a killing power much below that of tuberculosis, had been used for B.C.G. vaccination and to stress the advantages of treatment and the fact that the disease is curable and preventable, a great step forward would have been made. There is a considerable danger that the publicity attaching to poliomyelitis may force the problems of tuberculosis out of the public’s attention and also from the attention of the medical profession. There should be a shift of emphasis in the mass X-ray drive to make full use of all the voluntary services of a
SiR,-Dr. Pugh and Dr. Jeanes,
South-East
community. 1. Greene, R. 2. Greene, R.
J. Endocrin. 1950, 7, 1. In Memoirs of the Society for London, 1953; vol. 1, p. 16.
Endocrinology.