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Drugs: To Use or Not to Use. Weighing The Evidence Offered

Progress has been made with such giant strides in recent decades that one is tempted at times to bemoan the smallness of the territories still to be conquered. But for the pharmacologist at least, whatever the feeling may be in other circles, there exists a sufficient and powerful antidote for his ego in the large list of areas in which drugs are still badly needed. The things we might expect from these drugs, drugs that are not yet found or devised, are shown in Tables 3 and 4.

Table 3. Drugs Are Still Needed To Provide Prophylaxis Or Cure In:
common cold trichomoniasis infertility
virus influenza fluke infestations threatened abortion
brucellosis pneumonoconioses hyperemesis gravidarum
virus encephalitides renal disease eclampsia
foot-and-mouth disease portal cirrhosis endometriosis
leptospirosis peptic ulcer menstrual disturbances
rabies ulcerative colitis cataracts
trypanosomiasis many of the psychoses glaucoma
yellow fever parkinsonism impaired hearing
infectious mononucleosis cerebral palsy infantile colic
virus hepatitis migraine urolithiasis
smallpox Bell’s palsy anuna
tetanus Meniere’s disease obesity
schistosomiasis Sydenham’s chorea alcoholism malignancy
the mycoses multiple sclerosis and the muscular atrophies and dystrophies and syringomyelia burns
poliomyelitis shock of irreversible degree
dengue

Table 4. Drugs Are Still Needed To:
prevent atherosclerosis replace blood-letting in polycythemia vera and blood transfusion in shock
prevent hypertension
prevent development, check progress, even cause retrogression of valvular lesions correct the defects in hemophilia and in purpura
combat the circulatory and respiratory dissolution associated with pulmonary embolism
act more selectively in the autonomic nervous system
combat rheumatic carditis and rheumatoid arthritis specifically
restore circulation in the peripheral vascular diseases
end the disturbed uric acid metabolism in gout
attack dermatologic lesions effectively systemically separate the pharmacologic (useful) from thephysiologic (harmful) actions of ACTH
combat anemias other than the simple iron deficiency and pernicious types
combat intractable pain with non-addicting agents

This is a wonderful list, is it not? All this still left for the pharmacologist to do. And of course he will eventually do most of it, but there is something between him and the practitioner — a great vested interest which must sell to live. This vast pharmaceutical industry has become a familiar and essential ingredient of medical practice, and we should all generously and gladly attempt to be useful to it in recognition of a mutual interest and a shared desire. But this must not be done through yielding independence or sacrificing the intelligent approach!

Do not, I implore you, gain all the accretions to your pharmacologic knowledge from the paid sales representative, whose training is necessarily not comparable with yours, or accept the receipt of his sample as a mandate to use it. And do not believe the bromide that no one can keep up with medical advances today, for there are numerous existing abstract, year book, review and other services which make it quite possible to do so sufficiently well for practical and satisfying purposes. The expenditure of only a minimal amount of time is required too, if one’s time slices are adequately cut with this in mind. Most of you are keeping up better than you are told that you are.

And then there are the advertisements, the gorgeously colored spreads that make it difficult to find the reading matter in many of our journals. Please, if you must study the more gaudy of them at all, do so with a sour skepticism and a jaundiced and cynical eye. Be advised and aware that in some instances the journal references embodied in these advertisements are to preliminary findings that do not apply at all directly to the clinical claims that are made, and that in other instances the references are to publications that have actually been written by the pharmaceutical house staff itself for the inexperienced investigators who have made the clinical trials. The fact is that there are not enough existing facilities, and fully qualified clinical research workers, to perform the kind of studies that every new drug should have before it is made available for uncontrolled use in practice.

Publish date: 1959

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