Proprietary medicine

“ Hence it is that we claim it to be impossible for any one to put up any set prescription, or proprietary medicine, that will meet the wants of a large percentage of this class of cases. The only rational course to be pursued is to examine carefully each case as it is presented; find out the exact condition and stage of the disease with which the patient is afflicted, and then prescribe for it such special medicines as are nicely and exactly adapted to the patient's condition. ”

“ The profits to be made by a pharmaceutical house from the sale of a staple drug—a pharmacopeial, National Formulary, or nonproprietary preparation—which enters into free competition with other drugs of the same kind, are moderate; the profits to be made from the sale of a proprietary medicine on which the manufacturer holds a monopoly are usually large—sometimes enormous. ”

“ The complexity of modern medicine, especially in the pharmacologic field, has made it a physical impossibility for physicians to know the scientific status of scores of pharmaceutical products put out under proprietary or brand names. It was recognition of this fact that brought about the creation by the American Medical Association of the Council on Pharmacy and Chemistry. ”

“ It has been repeatedly stated in The Journal that many of the proprietary mixtures—the so-called ethical proprietaries advertised to physicians—were no better and no worse than “patent medicines” advertised to the public.
Every physician who has the welfare of medicine at heart should put these questions squarely to himself if he has not already taken a firm stand on this whole problem: What is my attitude toward the work of the Council? Are its reports worthy of acceptance? ”

“ When the history of the “patent medicine” business comes to be written impartially and fairly, it will be realized that we, the medical profession, have been in no small degree responsible for its growth. Not a few widely advertised nostrums owe their commercial success solely to the ill considered use accorded them by physicians, to whom they were first exploited. As a well-known and brilliant advertising man once said:
“The patent medicine of the future is one that will be advertised only to doctors. ”

“ It is the only book in which he can find information relative to proprietary medicines that are worthy of his patronage. It will protect the physician who makes use of it against the wiles of the promoters of products not worthy of his patronage. ”

“ Never prescribe a proprietary remedy by its trade name. In so doing you advise the patient of what he is taking and in time he will buy it without your prescription or advice. If you are satisfied that the preparation is a good one and really has medicinal merit—which a few of them do—prescribe it, if you must, by formula. Don’t let the patient know what you are giving him.
The money in the practice of medicine is in mystery. People don’t attach much importance or value to things that they know. It is the mysterious that commands their attention—and money. ”

“ Whether manufacturers anticipated the profession’s resentment toward the claim that physicians determine the treatment and perhaps the diagnosis by means of the statements on labels, or because the Shirley amendment to the Food and Drugs Act makes the proprietor responsible for therapeutic claims on the label of a medicine, it is a fact that fewer preparations than formerly need to be refused on account of infringement on this rule. ”

“ One characteristic of the “patent medicine” business is that it trades on fear. Should an epidemic occur the market is flooded with new nostrums purporting to cure or prevent the disease in question, while the manufacturers of older “patent medicines” revamp their advertising so as to make it appear that their preparations are all that stand between the scourge and the public. ”

“ Editorial Note.—What a comment on American medicine that a concern can even contemplate the possibility of making a commercial success of the sale of such a silly nostrum as Alfatone! And yet, when one remembers that a proprietary in which oats constitutes one ingredient (“Pas-Avena”) for years has been advertised to physicians and presumably prescribed by them, it is not altogether inexplicable that business men should get the impression that the medical profession is “easy” enough to “fall for” anything in the line of proprietary mixtures. ”

“ Earnestly believing that the continued toleration of secret, semisecret, unscientific or untruthfully advertised proprietary medicines is an evil that is inimical to medical progress and to the best interest of the public, we declare ourselves in sympathy with, endorse and by our best efforts will further, the work which has been, and is being, done by the Council on Pharmacy and Chemistry of the American Medical Association in the attempt to eliminate this evil. ”

“ But if the contents of a medicine are concealed from the public generally, and the medicine is prepared by 235one who know its contents, and he sells the same, recommending it for certain diseases and prescribing the mode in which it shall be taken, and injury is thereby sustained by the person taking the same, the proprietor would be liable for the damage thus sustained. These proprietary or patent medicines are secret, or intended by the proprietors to be secret, as to their contents. They expect to derive a profit from such secrecy. ”

“ Presumably, as a business organization, the concern believes it will convince a sufficient number of physicians of the therapeutic efficacy of its product to pay for the cost of this advertising campaign. If it appraises the situation correctly there need no longer be any wonder expressed that in the recent suit against The Journal, “patent medicine” makers were able to enlist the help of medical men.— (From The Journal A. M. A., Sept. 16, 1916.) ”

“ The patent medicine interests naturally try to obscure the issue. By the art in which they are so skilful, they aim to suggest to the public that physicians are opposed to patent medicines, in order to drive patients to their offices. ”

“ 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. ”

“ So far from claiming that these proprietary medicines will cure all diseases, their manufacturers advise the afflicted that, in many complicated and delicate chronic affections, they are not sufficient to meet the wants of the case. ”

“ That the owner of Micajah’s Wafers holds stock in a corporate firm which manufactures proprietary medicines and toilet articles, advertised to the laity, should not militate for or against our right to market a meritorious preparation on strictly ethical lines to the medical profession, inasmuch as many of the largest drug houses cater to both the doctor and the proprietary interests, and several are actively engaged in exploiting so-called nostrums. ”

“ If a manufacturer, in the absence of statutory privilege, has the control over the sales of the manufactured article for which the complainant here contends, it is not because the process of manufacture is kept secret. In this respect, the maker of so-called proprietary medicines, unpatented, stands on no different footing from that of other manufacturers. ”

“ 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.)
PHARMACEUTICAL BARNUMS
Does the public love to be humbugged? We doubt it. ”

“ It would be hard to find better examples of mischievous proprietary medicines than these two products of the Micajah Company. “Twins of Efficiency,” they are called in an advertising pamphlet. The composition is not stated. A physician using the “twins” does so absolutely in the dark. To him they are secret preparations. He is encouraged to use them in a great variety of conditions in which other drugs are much more useful. Inevitably, physicians using them will be likely to overlook, or pass over, new growths, specific infections and diseases that require radical remedial measures. ”

“ But with other proprietary medicines it is quite clear that the makers cannot in the slightest degree believe in the claims they make; the “remedy” in these cases is some substance or mixture devoid of medicinal activity, or possessing some slight therapeutic property having no relation to the disease for which the nostrum is put forward as a cure. It is often, indeed, for inert preparations that the most extravagant and emphatic claims are made ”

“ Useful Drugs.—Since the domination of proprietary medicines, which was retarding medical advance and threatening therapeutic chaos, had been made possible only by the insufficient and inefficient instruction given in medical schools in subjects having to do with drugs, the Council appointed a Committee on Medical Teaching to secure the cooperation of teachers in materia medica, pharmacology and related branches. ”

“ The complainant, a manufacturer of proprietary medicines which are prepared in accordance with seeret formulas, presents by its bill a system, carefully devised, by which it seeks to maintain certain prices fixed by it for all the sales of its products, both at wholesale and retail. Its purpose is to establish minimum prices at which sales shall be made by its vendees and by all subsequent purchasers who traffic in its remedies. Its plan is thus to govern directly the entire trade in the medicines it manufactures, embracing interstate commerce as well as commerce within the state respectively. ”

“ The complainant, Dr. Miles Medical Company, an Indiana corporation, if engaged in the manufacture and sale of proprietary medicines, prepared by means of secret methods and formulas, and identified by distinctive packages, labels, and trademarks. It has established an extensive trade throughout the United States and in certain foreign countries. It has been its practice to sell its medicines to jobbers and wholesale druggists, who in turn sell to retail druggists for sale to the consumer. ”

“ While a report setting forth the objections to a proprietary is published but once, the firm’s laudatory pronouncement goes forth again and again until the Council’s report is completely overwhelmed and forgotten. Manufacturers of proprietaries not only keep in close touch with the practicing physician by means of house organs, special “literature,” or by traveling representatives, but many of the firms, through the meritorious lines of pills, tablets, tinctures, etc., which they put out, also obtain and hold the good will and confidence of a large proportion of the medical profession. ”

“ Naturally Rule 4 has been bitterly opposed by most proprietary firms. Arguing that many physicians dispense their own drugs, pharmaceutical firms have insisted that every medicinal preparation should bear on its label, not only the dose of the preparation, but also a statement of the diseases in which the article is indicated. ”

“ It is not surprising that proprietary remedies of the latter type flourish so long as physicians unthinkingly accept and prescribe them solely on the manufacturer’s valuation.
“The Council has practically the undivided support of manufacturers of medicinal chemicals; that is, of proprietaries of the first mentioned type. But pharmaceutical firms which have found it profitable to promote proprietaries of the second type—“specialties,” unscientific or ordinary mixtures of pharmaceuticals or biologic products sold under trade names—have not supported the Council. ”

“ The laboratory attempts to be to the members of the American Medical Association what the prescription pharmacist is, or should be, to the prescribing physician—a storehouse of chemical and pharmaceutical information. In the belief that an insufficient familiarity with the chemistry and pharmacy of drugs constitutes the chief reason for the extensive use of unscientific, worthless or fraudulent proprietary remedies, this service is rendered by the laboratory as a contribution to the cause of rational therapy. ”

“ Despite many obstacles thrown into its path, the Council on Pharmacy and Chemistry has serenely pursued its allotted tasks, corrected its mistakes, improved its methods, and today stands as the only medium to which the honest physician may turn for information—not misinformation—regarding proprietary articles. During the war the Council and the chemical laboratory were in close cooperation with the Surgeon-General’s Office, testing and investigating every article offered to the government for the treatment of sick soldiers. ”

“ Furthermore, some of these firms may gain the confidence of the medical profession through these high grade pharmaceuticals, and certain of their proprietaries may be of distinct therapeutic value but may fail to be acceptable for New and Non­official Remedies, because they do not conform to the reasonable rules of the Council. ”