Document 362KOvdNonZ4741xkd34dJb3

G. I_. M A I S O N , M. D. PRESIDENT RIKER LABORATORIES, In c . PO ST O FFICE BOX 3157 TERMINAL ANNEX L O S A N G E L E S 5 4 , CALI F O R N IA 6 A p r il 1955 D r . R o be r t Keho e T h e K e t t e r in g L a b o r a t o r y C o l l e g e o f M e d ic in e Eat o n A venue C o N CINATTI 19 O h io D ear B o b: Y o u r l o n g l e t t e r o f 3 0 M a r c h 1955 w a s d e e p l y a p p r e c ia t e d . M a y I F IR ST SA Y TH A T N EITH ER I NOR ANYONE A T R lK E R TOOK ANY UM BRAG E A T YOUR R E C E N T L E T T E R TO TH E A . M . A . . W e DIO NOT F E E L TH A T YOU W ER E TH R O W IN G B A R B S AT R lK E R OR AT US PE R SO N A L L Y . ! A SSU M E THAT YOU HAVE SE E N A C O PY OF N oR M A N K a R R S A N SW ER IN G L E T T E R TO TH E A . M . A . W H IC H I H O PE T H E Y W I L L P U B L I S H , B U T IN C A S E YOU H A V E N O T, I A P P E N D A CO PY OF IT . It W OULD INDEED BE A SO R RY W ORLD IF P E O P L E LIKE YOU AND I COULD NOT HAVE THE ST R O N G E ST D IF FE R E N C E O F O PINIO N ON M A TTER S OF M ED IC A L FACT OR M O R A L S, W ITHOUT THE D IF F E R E N C E IN T E R FE R IN G W ITH OUR F R IE N D S H IP . I W OULD LIKE TO ST A T E WHAT ! THINK IS THE CRUX O F OUR D IF FE R E N C E O F O P I N I O N . A s i S E E I T , Y O U A R E S A Y I N G -*-i O r A L C a L C I U M D l S O D I U M V e R S E N A T E S H O U L D N O T B E U S E D IN A N Y C A S E B E C A U S E E V E N I F IT I M P R O V E S L E A D E X C R E T I O N , IT W IL L HA V E A D E L E T E F iO U S E F F E C T U PO N P R O P H Y L A X IS A G A IN S T L E A D E X P O S U R E IN IN D U S T R Y . iO n T H E O T H E R H A N D , F E E L TH A T IF IT W IL L R EM O V E LEA D E F F E C T IV E L Y , IT SH O U L D BE U S E D IN T H O S E P E O P L E W H O S H O W A H IG H B L O O D L E A D , E V E N T H O U G H T H E Y M A Y H A V E N O SY M P T O M S AT TH E M O M E N T . T h IS M IGHT BE C ALLED A PR O PH Y L A X IS A G A IN ST SY M PT O M A T IC E X A C E R B A T IO N . T h IS IS T H E O NLY KIND O F PR O P H Y L A X IS W HICH I F E E L IS A C C E P T A B L E AND M O R A L . 1 D E F IN IT E L Y DO N O T N O W A N D N E V E R H A V E F E L T T H A T N O R M A L P E O P L E IN IN D U ST R Y SH O U L D T A K E T H IS DRUG IN A N T IC IP A T IO N O F B E IN G E X P O S E D OR W H IL E T H E Y A R E B E IN G EX PO SE D TO L E A D . It S E E M S TO ME THAT IT W AS UNFO RTUNATE THAT THE TERM PR O PH Y L A X IS W AS U SE D A T A L L , S IN C E P R O P H Y L A X IS A G A IN S T E X A C E R B A T IO N IS SO R E A D IL Y C O N F U SE D W ITH PR O P H Y L A X IS A G A IN ST LEA D A C C U M U LA TIO N BEFO R E OR DURING THE F A C T . A SEC O N D D IF FE R E N C E O F O PIN IO N IS OVER A Q U ESTIO N OF F A C T . F r o m YOUR L E T T E R I G A T H E R T H A T Y O U W E R E T A K E N IN B Y T H E E X P E R IM E N T A L D A T A O F R l E D E R ON T H E R A B B IT . T h i s W A S , AT B E S T , A POOR E X P E R IM E N T S IN C E TH E R A B B IT S DID N O T HAVE A D ISE A SE ANALOGOUS TO THE HUMAN D IS E A S E , TH EIR M E TA BO LISM DOES NOT R E SE M B L E HUMAN M E T A B O L IS M IN T H E S E R E G A R D S , S O M E O F T H E M E T H O D S U S E D W E R E A L IT T L E L E S S TH A N A C C E P T A B L E , A ND TH E D URATIO N O F TH E E X P E R IM E N T W A S O PEN TO C R IT IC IS M . F u R T H E R WORK B Y R lE D E R H IM S E L F A N D A T L E A S T T W O O T H E R L A B O R A T O R IE S DO N O T IN A N Y S E N S E C O N F IR M N9766 --2-- THAT MAN BEH A V ES TH E W AY R lE D E R S R A B B IT S S E E M TO BEH A V E. P R E S E N T EV ID EN CE r S U G G E S T S TH A T ORAL. C a L C IU M D lS O D IU M V e r S E N A T E WILL. IN C R E A SE TH E OVERm A L L E X C R E T IO N O F L E A D IN P A T I E N T S W IT H A HIGH BL O O D L E A D A N D N O T T A K E T H E L E A D O U T OF THE A L IM E N T A R Y TR A C T AND PU T IT OUT THROUGH THE K ID N E Y S. In TH IS Q UESTIO N OF FA C T, O BVIO USLY TIM E AND TH E PU BLICA TIO N OF PA PE R S W IL L E V EN TU A LLY BRING US TO TH E SA M E PO IN T O F V IE W . In THE OTH ER Q U E ST IO N O F JUDGE M E N T , M O R A L S , E T C ., IT M A Y W E L L BE T H A T W E W IL L C O N T IN U E TO S T A N D A P A R T . I S H A L L HAVE NO TR O U BLE R E SP E C T IN G YOUR V IE W OR C O N TIN U IN G TO HAVE A G R EA T FO N D N E SS FOR THE M AN WHO GENERATED THAT PO IN T O F V IE W . I SIN C E R E L Y HOPE YOU W ILL FE E L THE SA M E W AY. I H O PE A L S O T H A T YOU FO UN D NO C A U S E FO R U M B R A G E IN N O R M K a RRS L E T T E R . It HAS BEEN A LONG T IM E S IN C E WE HAVE HAD A Q U IET EVENING TOGETHER AND I HAVE VERY P L E A SA N T R EC O LLEC T IO N S O F THE O N ES WE HAD B E FO R E . I SIN C E R E L Y HOPE THAT L o SS O M E B U S I N E S S W I L L B R I N G Y O U T O A n G ELES AND ALLOW YOU A R E SP IT E TO PU T YOUR FEET UP AT OUR HOUSE. W it h k in d e s t p e r s o n a l r e g a r d s , I a m , S in c e r e l y y o u r s , GLMime w "Ge o r g e L^,./Ma i s o n 0003320 M arch 30, 1955 D r. G eorge L. M aison V ice P resid en t and G eneral M anager R iker L ab oratories, Inc. P . O. Box 3157, T erm inal Annex Los A ngeles 54, C alifornia D ear D octor M aison: A recent note from M anfred Bow ditch, plus som e previous com m ents that have com e to m y attention from other so u r ce s, have indicated that som e of our colleagu es b eliev e or assu m e that m y recent editorial in the JAMA was d irected at your group in the R iker L a b o ra to ries. I should lik e to d isc la im any such pu rp ose or attitude on m y part, for if I had had anything of that type on m y m ind, I would fir s t have d irected it to you . T h ere m a y be o th e r s who b e lie v e th at yo u r group is open to c r itic is m , and they m ay be right, in term s of the p o ssib le or potential e ffects of the prom ulgation of the broad u se of the v ersen a te for p ro p h ylactic p u rp o ses, but that was not the point of m y rem a rk s, and i had and have no know ledge of any activity on your part that d eserved m y criticism . My pu rp ose was and rem a in s devoted to the d isco u ra g em en t of the u se of any m edical treatm ent of industrial workm en as a substitute for sound m easu res of industrial hygiene. None of us ha3 any justification for participating in any a ctiv ity that w ill have that effect. I am so w ell acquainted with the lead trad es and with the problem s which they p resen t and with the m eans by which th ese problem s can be handled, that I said what I did w ithout r ese rv a tio n and in the fu ll know ledge that I am right, m ed ically, m orally and hum anly speaking. I was directing m y rem arks at a group of industrial p h ysician s, who through ignorance, in sen sitiv ity of so cia l co n scien ce, or sh eer ca llo u sn ess to human w elfare, a re w illing to pander to the w ish es of uninform ed or irresp o n sib le in d u strial m anagem ent. T here is no p resen t excu se for the continued ex isten ce of dangerous exposure to lead in A m erican industry. A ccid en tal and u n fore seen absorption of lead w ill continue to occu r in our com plicated so ciety , but sa tisfa c to r y m ethods of con trollin g exp osu re to lead in the conventional lead trades of the USA are availab le and a re being used by com petent and responsible industrial organizations. T his is what I w as a ttem p tin g ,p rim a rily , to sa y as sim p ly and a s d ir e c tly a s I knew h ow , and jam not a t a l l happy a t b ein g th ought to h a v e b e e n N 9 7 6 6 .0 1 D r. G eorge L . M aison - (2) - M arch 30, 1955 sp e a k in g to an y o th e r p u r p o s e . It i s tr u e , a s I s a id , th at th e e v id e n c e fo r the use of the drug safely is not availab le, at le a st to m e. But if it can be shown that it is en tirely h a r m le ss, of itse lf, in this u se , I am still bitterly op p osed to su ch u se to p a llia te the e ffe c ts o f h azard ou s ex p o su re to le a d in industry. M oreover, I know that if its prophylactic u se is w idely and u n reserv ed ly encouraged, even in ju stifiab le situations for which no one is know ingly to b la m e, it w ill be em p loyed a s a ju stific a tio n fo r the m ed ica l protection of m en who should have adequate environm ental protection . This is a m atter in w hich the co n scie n c e s of m ed ical m en w ill have to rem ain sen sitiv e, or we a re in for a relap se in the p resen t encouraging and m uch too long delayed application of sound standards and p ra ctices of ind ustrial h y g ie n e . I have felt that th is statem ent of m y p osition was due you and your a s s o cia te s a s w ell as due m y se lf, in view of the p erso n a l and p ro fessio n a l a m e n itie s w hich should p r e v a il b etw een u s, and w hich I should lik e to preserve. Sincerely yours, RAK ef Robert A. Kehoe, M. D.