The preceding paragraph, quoted from a bulletin issued in 1919 by the Indiana State Board of Health, brings vividly to one’s atten tion a serious condition of public health in our country. The evil of patent medicines, the subject of this article, is especially hard to com bat because the manufacturers and vendors of these remedies are constantly spending such huge sums of money in clever and extensive advertising and because the American public so readily believes their claims. The term, patent medicines, will be used in this article to include the host of medicinal preparations on the market which are not official. Comparatively few are protected by patent or trade-mark, but for convenience all will be included under the one term. The greatest evils caused by the exploitation of patent medicines are:
1. The constant suggestion to well people that they are sick. It is well known how easily imaginative symptoms can be created in some types of mind. An attractive poster setting forth the claims of Dr. Carter’s Little Liver Pills, for instance, will lead many a person to think, “Perhaps those queer feelings I have arc due to my liver. I’ll try those liver pills.” So the purpose of the advertisement is attained, a demand is created, and one more person is experiment ing in self-medication.
2. Encouragement of self-medication. This is especially dan gerous in such diseases as diabetes, tuberculosis, cancer, syphilis and the like. The early symptoms of these diseases may thereby be masked or treated ineffectually and medical advice delayed so that when proper treatment is secured it may be too late for a cure to be possible and meantime infection may be spread. The federal law prohibits any false and fraudulent claims for therapeutic effects from appearing on the label of a remedy or in circulars accompanying it and, since it cannot be proven that any remedy will be a “cure,” a claim to cure has been practically eliminated from label and circular. In 1915, the federal government ruled against “Father John’s Medi cine” because on the label of the bottle it was stated that this medicine was a prompt and efficacious remedy for lung disease. It was found to consist chiefly of cod-liver oil. According to statistics gathered by the National Tuberculosis Association, the public pays from $15, 000,000 to $20,000,000 a year for fake cures for tuberculosis and no doubt equally large amounts are spent for so-called cures of other diseases of equally serious nature.
3. Secrecy of composition. Every person has a right to and should know what he is taking into his system, especially if the rem edy or any ingredient of it is a habit-forming drug. It is simple to take a remedy but not simple to take it back or to cure its bad effects. It has been estimated that 75,000,000 pounds of drugs and chemicals are poured every year into our delicate mechanisms and most of it is self-administered without any adequate knowledge of its composition or its rational use. How many people who take Bromo Seltzer, fre quently, at soda fountains, know that they are taking acetanilid, a habit-forming drug? For a long time Syrup of Figs was so adver tised that one supposed it to be a concentrated fluid preparation of the fruit, but the law for honest labels brought out the fact that it was an elixir of senna flavored with syrup of figs.
4. High cost of useless remedies or of patented names of well established ones. Sanatogen, for example, was at one time widely advertised as “the re-creator of lost health” and “the most reliable and scientific of all nutrients.” It was found to be a form of casein with a small amount of sodium glycerophosphate. It might produce a gain in weight, as was claimed, but at what price? One dollar’s worth of Sanatogen would yield 332 calories, while one dollar’s worth of eggs (3 cents apiece at the time) would yield 2,600 calories, and one dollar’s worth of milk (7 cents at the time) 8,850 calories. The official drilff, hov«mothylenamino. я urinary antiseptic, when purchased under its own name, cost 35 cents* for one hundred 7>/j grain tablets, while the same remedy under a protected name. Urotropin, sold for $1.25 for one hundred 71/2 grain tablets.
The high price of Urotropin pays, not for a superior article, but for the advertising and the special form in which it is marketed. It has been said that where one dollar is spent in the interest of rational medicine, thousands of dollars are spent to increase the sale of patent medicines. A million dollar advertising campaign of Bayer’s Aspirin is now going on and it is a certainty that as a result many people who never needed Aspirin will be taking it, many will get the habit of taking it, and the price of advertising will be paid by the public. Such is the power of advertising and the susceptibility of the human mind. The principle of patenting an article is a good one, because the patent law requires a detailed description of the process to be patented or of the methods by which the article to be patented is made and the article and process must be new and original. To quote from the Journal of the American Medical Association. 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 extension of the nostrum busi ness. founded on the abuse of patent and trade-mark laws, it becomes a menace to the public health. The chief criticism of the patent office is lack of cooperation with authorities in the field of chemistry and medicine. Consequently patents are frequently issued for articles or processes that arc not new and which are worthless. For example, in 1912, a patent was granted on a cresol compound as a new and original substance which in 1903, was fully described in a chemical publication. Consultation by the patent office with chemical experts would have revealed this fact and the patent would not have been granted. In 191G. patent rights were granted on “Means for and Method of Stabilizing Secre tin,” a process claimed to be original, by which secretin was made in a form capable of resisting the action of the gastric juices. An investigation showed that the product of this process not only was not stable, but contained no secretin. Again consultation by the patent office with experts would have prevented the issuance of the patent. A patent grants a monopoly on an article or process for seventeen years. After that the name or process or both become public property unless a trade-mark is obtained. A trade-mark gives a perpetual monopoly on a name, but places no restriction on the composition. Its object is merely identification and protection against imitation. Mrs. Winslow’s Soothing Syrup, for example, is a name protected by trade-mark, but while it originally contained morphine and alcohol, it now contains neither. As stated above, while a patent lasts, the price of a remedy is frequently exorbitant. An ounce of thymol iodine costs about $1.30; of Aristol, the same drug under a fanciful name, $1.80. A pint of compound solution of cresol, U. S. P., costs 47 cents; of Lysol, practi cally the same thing, under a name originally patented, 75 cents. A pint of the antiseptic solution, N. F., costs 60 cents; of Listerine, an almost identical solution, 84 cents.
Aspirin is a good example of the cost to the public of a patented remedy. A patent was granted by this government, in 1900, to a German firm represented in this country by Bayer & Co., on both acetylsalicylic acid (Aspirin) and the process for making it. This was practically the only country which was willing to grant the patent and, as a consequence, for seventeen years no American manu facturer could make this simple chemical, hospitals and individuals were not allowed to import it, and the American people had to pay from six to ten times as much as was paid in the greater part of Europe, and three times as much as was paid just across the border in Canada. The patent expired in 1917, and the Bayer Company, successors to the German firm, attempted to secure a permanent monopoly over the name Aspirin by a trade-mark. The courts re fused to grant this. Acetylsalicylic acid is now unprotected and at least six different American firms are making it, in some cases using the name Aspirin. One hundred five-grain tablets of Bayer’s Aspirin cost 80 cents; one hundred five-grain tablets of Aspirin made by other American firms, proven equally good, cost 38 cents. The Bayer Company still claims a common-law right to the name Aspirin as its special property, but the claim is unwarranted and has not yet been granted by the courts. This company by extensive and misleading advertising is endeavoring to maintain its high price by educating the public to demand only its product. The following sen tences are quoted from one of its advertisements as examples of exaggerated statements: “To-day the name ‘Bayer’ holds a place in the everlasting affection and appreciation of the peoples of the entire world’’; “Aspirin • * * is found only in genuine ‘Bayer Tablets of Aspirin’.” Surely the nursing and medical professions should set their faces against any product so advertised. Patent and proprietary remedies may be advertised in two ways, directly to the public through newspapers, magazines, and posters, and indirectly through samples and circulars to physicians, and ad vertising in medical journals. The first method is mure expensive but brings quicker results.
The second is slower but the endorse ment of the physician gives the article a higher prestige. Often man ufacturers follow the indirect method by the direct. In popular usage, articles advertised directly are known as patent medicines, those indirectly as proprietary or ethical proprietary; but in medical literature, any medicine which is in any way protected is commonly termed proprietary, and those advertised indirectly as ethical proprietary. Many of the remedies on the market are not patented and never could be. because the manufacturers refuse to disclose the composition. The federal government exercises control over patent medicines under two laws. The Pure Food and Drugs Act and The Harrison Act. The regulations in regard to such remedies under the State Boards of Health and in some large cities, on the whole follow the principles of the federal laws and in some cases are more rigid and comprehensive. The Pure Food and Drugs Act applies to interstate commerce only, The Harrison Act, an anti-narcotic law, to intrastate commerce as well. Briefly, The Pure Food and Drugs Act is directed against interstate commerce in misbranded articles and misbranding includes “false or misleading” claims on the label and circulars with the pack age as to composition and origin and “false and fraudulent” claims as to therapeutic value. Unfortunately this law has no control over advertising matter which does not accompany the package. Dr. Groves’ Anodyne for Infants was ruled against by the fed eral government as a misbranded article, because investigation showed it to be a flavored sugar syrup of morphine and it was claimed to re move nervous irritability in children, to invigorate teething babies, and to be perfectly safe.
The government acted against a preparation of castor-oil capsules which contained from 50 to 70 per cent ot’ cottonseed oil. If the label states that certain tablets contain five grains of Aspirin, for example, each tablet must, under this law, con tain five full grains of acetylsalicylic acid. The law enforcing an honest label is a very great power in securing pure drugs. The federal law has no further control than this over the com position of remedies except in regard to habit-forming drugs. The Pure Food and Drugs Act requires a statement on the label of the presence and amount of alcohol, morphine, opium, cocaine, heroin, alpha- and beta-oucaine. chloroform, cannabis indica. chloral, acetan ilid and any derivatives or preparations of these drugs. The Harrison Act sets a maximum to the amount allowed in any remedy of morphine, opium, codeine, heroin, coca leaves, cocaine, alpha and betaeucaine and their compounds, derivatives, salts and preparations.’ The agency which is doing most to expose fraud in medicines and to disseminate knowledge as to Datent remedies is the American Medical Association with headquarters at 535 North Dearl>orn Street, Chicago. This special work is divided between the Propaganda for Reform Department which investigates and reports on the so-called patent remedies (those advertised directly to the public) and the Council on Pharmacy and Chemistry which deals particularly with the proprietary drugs (those advertised to physicians). The Propaganda for Reform Department has prepared and issued the following publications: Nostrums and Quackery, Great American Fraud, and about twenty pamphlets on similar subjects.
The Council on Pharmacy and Chemistry publishes every year a book called New and Non-Official Remedies, in which is given a brief de scription of proprietary and non-propriotary preparations which are considered worthy of trial by physicians. Acceptance of an article for this book does not mean a recommendation, but merely that it conforms to certain standards set by the Council. The Council also publishes annual reports in which the unaccepted articles are described and the reasons for their non-acceptance given, and the most im portant of these are published at intervals in a book called Propa ganda for Reform. These publications are the only reliable sources of information about the flood of patent and proprietary medicines on the market. Upon application, a price list will be sent and free information will be given about any special preparation. Sal Hepatica is an interesting example of a remedy which is not accepted by the Council on Pharmacy and Chemistry. It is one of the best selling salines on the market. By analysis its active ingredi ents are shown to be approximately 13 per cent of salt, 26 per cent of sodium sulphate, 30 per cent of sodium phosphate and 18 per cent of sodium bicarbonate. It costs about twice as much as a mixture of these salts which any druggist could prepare. Sal Hepatica is ruled against by the Council because its composition is secret, the name fails to suggest its chief ingredient, and does suggest its use in liver troubles, the claims for its therapeutic effects are exaggerated and unwarranted, and it is advertised directly to the public. One does not ordinarily think of a preparation of this sort as a habit-forming remedy, but in the opinion of many authorities the worst habit of the American people in self-medication is that of taking cathartics and of these the saline cathartics are the most abused. A habit of taking saline cathartics leads to spastic constipation and resulting neuras thenia and it is not an easy habit to break.
It is estimated that there are from four to five thousand drugs and their preparations in everyday use in this country and naturally no course in Materia Medica or Pharmacology in a medical school or nurses’ training school, even if it were desirable, could cover the whole field. The American Medical Association publishes a small book entitled Useful Drugs containing a brief description of al>out 400 drugs, chemicals, and preparations, official and unofficial, which is intended as a guide for teachers in medical schools and for state ex amining boards. The compilers of this book hope to demonstrate to teachers that many drugs discussed in large text-books on Materia Medica are superfluous, that instruction in medical schools need cover only the drugs which are of proved value, and that many of the so-called “new” drugs are no better than the well-established ones. These principles may well be carried over into the nurses’ training schools. Many of these schools are now teaching Materia Medica from a doctor’s book which is almost literally an encyclopedia of drugs and the reason for its use, given by one instructor, was that “it has everything in it.” The choice of a text-book on that basis is contrary to good pedagogy and opposed to the principles of the lead ers of medicine who are striving to establish a rational limit to the use of drugs.
It would seem that the hospital training school could lend its assistance in the fight against patent medicines by (1) putting em phasis upon official drugs and preparations in all classes in Materia Medica; (2) by exposing to the pupil nurses the evils of exploitation of medicines of any sort; and (3) by encouraging the use in the hospital, so far as possible, of official drugs and those of established worth. The individual nurse should refuse to use for herself remedies of unknown composition, those which are widely exploited, and those for which extravagant claims are made, and she should take every opportunity among friends and patients to point the way by example and precept to pure drugs, at honest prices, honestly advertised.
