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The uses of absurdity or Student, Doctors, and Ultramodern Therapeutics
63 6
Correspondence
the Therapeutic Use of Penicillin, American Pediatric Society, Seventieth Annual Meeting, No. 32, p. 47. 2. Stevens, Kingsley M. : The Effect of Antibiotics Upon the Immune Response, J. ImmunoI. 71: 119, 1953. 3. Markowitz, Milton: Observations on an Epidemic of Streptococcal Infections and Recurrences of Rheumatic Fever Among Children Treated With P6nicillin, Pediatrics 20: 257, 1957. 4. Lira, Wan Njo, and Wilson, M. G.: Comparison of the Recurrence Rate of Rheumatic Carditis Among Children Receiving Penicillin by Mouth Prophylactically or on Indication, New England J. Med. 262: 321, 1960.
To the Editor: THE
USES
OF A B S U R D I T Y or
Students, Doctors, and Ultramodern Therapeutics
October 1960
come," as they "set" examinations for the fledglings who must have proper healing in their wings:
Comprehensive questions J. Name the 5 largest manufacturers of antibiotics. How do the salaries of their advertising managers compare with those of the average university or hospital investigators in the field of (a) Cancer? (b) Hematology? (c) Virology? 2. You are engaged in a clinical and statistical investigation of the efficacy of a certain company's broad-spectrum antibiotic preparation in the treatment of upper respiratory infections in your clinic and hospital. Do you swear (by Apollo and Panacea) to be completely impartial and objective in your evaluation of other competing commercial preparations?
Questions [rom the micro-print He is positively outdated who even remembers the days of courses in "Pharmacology and Therapeutics," when prescription-writing was indeed prescription-writing! I don't mean the old polypharmacy in mystic Latin, with "M. et ft. ungt.," or "Tai. charts, no." on the end. I mean when graduates in medicine relied upon pharmacists or apothecaries who wielded pestle and mortar and nicely balanced scales. Then physicians and pharmacists alike had to blow their "incompatibilities"--a now happily forgotten word. Nowadays druggists read off trade names from prescriptions, or "take" them over the phone, then pour solutions from big bottles into little ones, or more often hand out ready-filled bottles or boxes, with the doctor's name and directions copied thereon. Let it be cheerfully noted that what we now prescribe benefits the patient far more than did the "compounded-on-the-spot" mixtures of yesteryear. Are the departments of pharmacology, medicine, pediatrics, etc., of our medical schools streamlined to keep up with the newer methods of dispensing "drugs"--for such we continue to call both antibiotic and chemotherapeutic agents. How do our medical schools and licensing boards go about evaluating the proficiency of their candidates in the all-important field of modern therapeutics ? Let them give heed to the following examples of "what might be," or "the shape of things to
1. You have just written a prescription for tablets of 6-chloro-7-sulfamyl-3, 4-dihydro-1, 2, 4benzothiadiazine-1, l-dioxide. For what condition or conditions should this medication be efficacious? What is its short and commonly used trade name? 2. Select any 5 of the following 8 advertised preparations, and give the chemical formula for each, together with the conditions for which each is indicated: (a) Plaquenil (b) Stelazine (c) Appetrol (d) Clarin (e) Naturetin with K (f) Trilafon (g) Preludin (h) Tral 75 mg. Gradumet The reader has recognized the foregoing for what it is: a reduetio ad absurdum set forth to indicate a trend.
The Lesson (For the physician who holds fast to the conviction that he and his profession exist for the benefit of the patient.) We now have at our disposal remedies far exceeding in value anything our forebears ever dreamed of--remedies which must be produced in bulk by properly regulated and supervised commercial houses. Free enterprise being what it is, the doctor who gives his patient's welfare prime consideration should give well-nigh equal
Volume 57
Number 4
place to the line from his Hippocratic oath: "I will reckon him who taught me this Art equally dear to me as my parents." For "him" we now read "Medical Faculty." Let the harassed physician keep in closer touch than ever with the ways and men of the medical school. For here he may expect still to find science, pure and undefiled. Here, he will gain the refuge he must have from the blandishments of those who sell. Here will be Brutus' "honesty to honesty engaged." Valuable, essential as they are in "our way of life," the commercial houses must compete. What Hygeia was to Panacea, Advertising is to Free Enterprise: sister. And the Antidote to Advertising Run Riot is Sales Resistance. Con[erences, scientific meetings (yea, even those financed in part by these same commercial houses with their competing exhibits)--where truth and free speech prevail, and where facts are dispensed in profusion by those engaged in research and teaching--it is from regular attendance at such gatherings in hospitals find medical schools that the true physician will derive what
Correspondence
637
he--and his patient--needs. The doctor who is too busy to go to such meetings, or to read his medical journals is--too busy. Even his medical journals, please note, are financed by the advertising, lurid at times, of the drug houses referred to above. Now, more than ever, the physician must realize that others know more about many things than he does. They may be old instructors or new colleagues. He must keep learning from them "what's going on." He must let them help him keep his balance amid all the forces working upon him. Modern developments practically require that we use trade names. None can keep all the complex chemical formulas at his tongue's end. None needs to be overwhelmed by the welter of advertising, nor by the suave, polysyllabic claims of "detail men." The hard-won principles of scientific medicine need not, must not, be abandoned. P A R K J . W H I T E , M.D. ST. LOUIS~ MO.
Correspondence
the Therapeutic Use of Penicillin, American Pediatric Society, Seventieth Annual Meeting, No. 32, p. 47. 2. Stevens, Kingsley M. : The Effect of Antibiotics Upon the Immune Response, J. ImmunoI. 71: 119, 1953. 3. Markowitz, Milton: Observations on an Epidemic of Streptococcal Infections and Recurrences of Rheumatic Fever Among Children Treated With P6nicillin, Pediatrics 20: 257, 1957. 4. Lira, Wan Njo, and Wilson, M. G.: Comparison of the Recurrence Rate of Rheumatic Carditis Among Children Receiving Penicillin by Mouth Prophylactically or on Indication, New England J. Med. 262: 321, 1960.
To the Editor: THE
USES
OF A B S U R D I T Y or
Students, Doctors, and Ultramodern Therapeutics
October 1960
come," as they "set" examinations for the fledglings who must have proper healing in their wings:
Comprehensive questions J. Name the 5 largest manufacturers of antibiotics. How do the salaries of their advertising managers compare with those of the average university or hospital investigators in the field of (a) Cancer? (b) Hematology? (c) Virology? 2. You are engaged in a clinical and statistical investigation of the efficacy of a certain company's broad-spectrum antibiotic preparation in the treatment of upper respiratory infections in your clinic and hospital. Do you swear (by Apollo and Panacea) to be completely impartial and objective in your evaluation of other competing commercial preparations?
Questions [rom the micro-print He is positively outdated who even remembers the days of courses in "Pharmacology and Therapeutics," when prescription-writing was indeed prescription-writing! I don't mean the old polypharmacy in mystic Latin, with "M. et ft. ungt.," or "Tai. charts, no." on the end. I mean when graduates in medicine relied upon pharmacists or apothecaries who wielded pestle and mortar and nicely balanced scales. Then physicians and pharmacists alike had to blow their "incompatibilities"--a now happily forgotten word. Nowadays druggists read off trade names from prescriptions, or "take" them over the phone, then pour solutions from big bottles into little ones, or more often hand out ready-filled bottles or boxes, with the doctor's name and directions copied thereon. Let it be cheerfully noted that what we now prescribe benefits the patient far more than did the "compounded-on-the-spot" mixtures of yesteryear. Are the departments of pharmacology, medicine, pediatrics, etc., of our medical schools streamlined to keep up with the newer methods of dispensing "drugs"--for such we continue to call both antibiotic and chemotherapeutic agents. How do our medical schools and licensing boards go about evaluating the proficiency of their candidates in the all-important field of modern therapeutics ? Let them give heed to the following examples of "what might be," or "the shape of things to
1. You have just written a prescription for tablets of 6-chloro-7-sulfamyl-3, 4-dihydro-1, 2, 4benzothiadiazine-1, l-dioxide. For what condition or conditions should this medication be efficacious? What is its short and commonly used trade name? 2. Select any 5 of the following 8 advertised preparations, and give the chemical formula for each, together with the conditions for which each is indicated: (a) Plaquenil (b) Stelazine (c) Appetrol (d) Clarin (e) Naturetin with K (f) Trilafon (g) Preludin (h) Tral 75 mg. Gradumet The reader has recognized the foregoing for what it is: a reduetio ad absurdum set forth to indicate a trend.
The Lesson (For the physician who holds fast to the conviction that he and his profession exist for the benefit of the patient.) We now have at our disposal remedies far exceeding in value anything our forebears ever dreamed of--remedies which must be produced in bulk by properly regulated and supervised commercial houses. Free enterprise being what it is, the doctor who gives his patient's welfare prime consideration should give well-nigh equal
Volume 57
Number 4
place to the line from his Hippocratic oath: "I will reckon him who taught me this Art equally dear to me as my parents." For "him" we now read "Medical Faculty." Let the harassed physician keep in closer touch than ever with the ways and men of the medical school. For here he may expect still to find science, pure and undefiled. Here, he will gain the refuge he must have from the blandishments of those who sell. Here will be Brutus' "honesty to honesty engaged." Valuable, essential as they are in "our way of life," the commercial houses must compete. What Hygeia was to Panacea, Advertising is to Free Enterprise: sister. And the Antidote to Advertising Run Riot is Sales Resistance. Con[erences, scientific meetings (yea, even those financed in part by these same commercial houses with their competing exhibits)--where truth and free speech prevail, and where facts are dispensed in profusion by those engaged in research and teaching--it is from regular attendance at such gatherings in hospitals find medical schools that the true physician will derive what
Correspondence
637
he--and his patient--needs. The doctor who is too busy to go to such meetings, or to read his medical journals is--too busy. Even his medical journals, please note, are financed by the advertising, lurid at times, of the drug houses referred to above. Now, more than ever, the physician must realize that others know more about many things than he does. They may be old instructors or new colleagues. He must keep learning from them "what's going on." He must let them help him keep his balance amid all the forces working upon him. Modern developments practically require that we use trade names. None can keep all the complex chemical formulas at his tongue's end. None needs to be overwhelmed by the welter of advertising, nor by the suave, polysyllabic claims of "detail men." The hard-won principles of scientific medicine need not, must not, be abandoned. P A R K J . W H I T E , M.D. ST. LOUIS~ MO.