HOW DOCTORS LEARN THE EASY WAY
Mintz, Morton
How Doctors Learn the Easy Way by MORTON MINTZ One day in 1952, Dr. Albe M. Wat-kins of La Canada, California, went to his medicine cabinet for a drug with which to treat his son, James, ten, who...
...Perhaps a few thousand persons a year in this country should get the drug, which has the generic name chloramphenicol, for typhoid fever, principally...
...The otherwise informed physician is thereby grossly misled...
...A. Dale Console, a former medical director of E. R. Squibb & Sons, said, "There is a simple maxim I learned from detail men...
...If you can't convince them, confuse them.' " The medical profession speaks of an inviolable "right" to prescribe as it sees fit...
...David L. Edsall...
...At Senator Nelson's hearings, however, the situation was put in an unusual perspective by a witness who spoke both as a physician and as a lawyer...
...Keep the sincerity flag of good eye-contact flying...
...A rare insight into the kind of indoctrination given detail men was provided last October in the Sunday Times of London after its correspondent Tony Clifton came across a pamphlet distributed by Merck & Co...
...These physicians may have forgotten an admonition of their ancient mentor, Hippocrates...
...The physician passed up several preparations in favor of Chloromycetin...
...Watkins was one of three similarly bereaved California fathers who told their stories at recent hearings held by Senator Gaylord Nelson, Wisconsin Democrat and chairman of the Subcommittee on Monopoly of the Senate Select Small Business Committee...
...In his work "On Wounds of the Head," he cautioned against those who "praise what seems outlandish before they know whether it is good, rather than the customary, which they already know to be good...
...Franklin Farman, a Lakewood urologist whose only child, Mary Ann, five, also died in 1952, and Edgar F. Elf-strom, publisher of the Daily News Tribune in Fullerton, whose daughter Brenda Lee, nineteen, the youngest of four, died in 1960...
...The other witnesses were Dr...
...One instruction was, "Develop eye-contact habits that help to signal sincerity...
...Three months later, the boy was dead of aplastic anemia, a blood disease...
...The spectacle astonishes one now that it can be viewed from the perspective of growing distance: a learned scientific profession doing about one half of what is its chief work—treating the sick—on the strength solely of information received from advertisements and detail men...
...Blame also attaches to the Food and Drug Administration, which until the Nelson hearings had not acted vigorously to reduce the hazard...
...training, a great many physicians, in 1968 as in 1952—entrust their postgraduate education to drug companies...
...He went on to testify that in his own experience as a general practitioner, "I do not recall the Parke, Davis detail men ever discussing the relationship between administration of the drug and the development of blood dyscrasias...
...This was said not in 1968, but in 1910, in a report on medical education in the United States by the great American educator, Abraham Flexner...
...But what the fathers and other witnesses made clear as never before was the primary responsibility of physicians...
...William C. Hewson of Philadelphia, was from 1958 to 1964 in general medical practice in West Chester, Pennsylvania...
...Yet for sixteen years the use of this antibiotic has persisted and even increased...
...the bizarre rather than the obvious...
...Blame of course attaches to the company, which has made tens of millions of dollars on Chloromycetin...
...In testimony before the late Senator Estes Kefauver, Dr...
...The great disservice of the detail men is not in their exaggeration of a drug's beneficial uses but in their approach to its toxic effects," he told the Nelson Subcommittee...
...Watkins relied when he administered Chloromycetin to his son had been conveyed to him in a visit from a salesman, or detail man, from Parke, Davis...
...to its representatives in the United Kingdom...
...Then he went to law school...
...At the same time, its members in large numbers allow themselves to be educated in the exercise of that "right" by profit-motivated corporations...
...This too was said not in 1968, but, by coincidence, also in 1910, in an article in the Journal of the American Medical Association by Dr...
...Of the many physicians I have talked to with regard to these detailing methods not one has stated that the Parke, Davis man voluntarily brought the toxicity to the physicians' attention...
...The manufacturer of this antibiotic, Parke, Davis & Co., had told him that Chloromycetin was "perfectly safe...
...Parke, Davis's concept of ethical behavior is illuminated by its practice of advertising the drug in foreign medical journals without the warnings that it is required by law to include in American medical journals...
...The spectacle remains astonishing although the distance has grown in time by more than a half-century...
...The laity . . . has more to fear from credulous doctors than from advertisements themselves: for a nostrum containing dangerous drugs is doubly dangerous if introduced into the household by the prescription of a physician who knows nothing of its composition and is misled as to its effect...
...But in 1960 it was given to an estimated four million Americans, a number of whom died of aplastic anemia...
...Like almost all among hundreds of such aplastic anemia deaths, these had been needless— the result of the prescribing of Chloromycetin for colds or other trivial ailments which no medicine cures, or for conditions in which other drugs are safer...
...His agony had been so great and so prolonged that, his father said in a letter to Parke, Davis, "I might have done better had I taken a gun and shot him...
...Albe M. Wat-kins of La Canada, California, went to his medicine cabinet for a drug with which to treat his son, James, ten, who had an infection of the urinary tract...
...The witness, Dr...
...Another guideline was, "When the doctor invites you to take a chair, sit animatedly...
...A few months ago, he won a $215,000 jury award for the estate of Mary Ann Incol-lingo, a child who died of aplastic anemia after receiving Chloromycetin needlessly...
...Commonly the toxicity is not discussed thoroughly, is played down, or is not even broached...
...He wrote "The Therapeutic Nightmare," published in hard cover by Houghton Mifflin and later reissued in paperback by Beacon Press under the title, "By Prescription Only...
...The assurance of safety on which Dr...
...look your customer right in the eye...
...His poignant testimony underscored a depressing point—that despite five to twelve years of medical MORTON MINTZ, a reporter for The Washington Post, won the Raymond Clapper, Heywood Broun, and George Polk awards for his 1962 reporting of the thalidomide tragedy...
...To an extent true of no other prescription drug, experts have warned the medical profession about Chloromycetin and pleaded for restraint in its use...
Vol. 32 • June 1968 • No. 6
