Document 3QkYaaqXROVaaNGv025bGpwpn

G. L. MAISON, M. D. PRESIDENT RIKER LABORATORIES, In c . POST OFFICE BOX 3157 TERMINAL ANNEX LOS ANGELES 54, CALI FORN IA 6 Ap r i l 1955 Dr . Ro b e r t Ke h o e Th e Ke t t e r i n g La b o r a t o r y Co l l e g e o f Me d i c in e Ea t o n Av e n u e Co NCINATTI 19 Oh i o De a r Bo b : Yo u r l o n g l e t t e r o f 30 Ma r c h 1955 w a s d e e p l y a p p r e c ia t e d . Ma y I FIRST SAY THAT NEITHER I NOR ANYONE AT RlKER TOOK ANY UMBRAGE AT YOUR A.M.A.. WRECENT LETTER TO THE e DIO NOT FEEL THAT YOU WERE THROWING BARBS AT RlKER OR AT US PERSONALLY. I ASSUME THAT YOU HAVE SEEN A COPY OF NoRMAN Ka RRS ANSWERING A.M.A. ILETTER TO THE WHICH HOPE THEY WILL PUBLISH, BUT IN CASE YOU HAVE NOT, I APPEND A COPY OF IT. It WOULD INDEED BE A SORRY WORLD IF PEOPLE LIKE YOU AND I COULD NOT HAVE THE STRONGEST DIFFERENCE OF OPINION ON MATTERS OF MEDICAL FACT OR MORALS, WITHOUT THE DIFFERENCE INTERFERING WITH OUR FRIENDSHIP. I WOULD LIKE TO STATE WHAT I THINK IS THE CRUX OF OUR DIFFERENCE OF OPINION. As I SEE IT, YOU ARE SAYING -*-i Or AL Ca LCIUM DlSODIUM Ve RSENATE SHOULD NOT BE USED IN ANY CASE BECAUSE EVEN IF IT IMPROVES LEAD EXCRETION, IT WILL HAVE A DELETEFiOUS EFFECT UPON PROPHYLAXIS AGAINST LEAD EXPOSURE IN INDUSTRY. On THE OTHER HAND, i FEEL THAT IF IT WILL REMOVE LEAD EFFECTIVELY, IT SHOULD BE USED IN THOSE PEOPLE WHO SHOW A HIGH BLOOD LEAD, EVEN THOUGH THEY MAY HAVE NO SYMPTOMS AT THE MOMENT. Th IS MIGHT BE CALLED A PROPHYLAXIS AGAINST SYMPTOMATIC EXACERBATION. Th IS IS THE ONLY KIND OF PROPHYLAXIS WHICH I FEEL IS ACCEPTABLE AND MORAL. 1 DEFINITELY DO NOT NOW AND NEVER HAVE FELT THAT NORMAL PEOPLE IN INDUSTRY SHOULD TAKE THIS DRUG IN ANTICIPATION OF BEING EXPOSED OR WHILE THEY ARE BEING EX POSED TO LEAD. It SEEMS TO ME THAT IT WAS UNFORTUNATE THAT THE TERM PROPHYLAXIS WAS USED AT ALL, SINCE PROPHYLAXIS AGAINST EXACERBATION IS SO READILY CONFUSED WITH PROPHYLAXIS AGAINST LEAD ACCUMULATION BEFORE OR DURING THE FACT. A SECOND DIFFERENCE OF OPINION IS OVER A QUESTION OF FACT. Fr o m YOUR LETTER i GATHER THAT YOU WERE TAKEN IN BY THE EXPERIMENTAL DATA OF RlEDER ON THE RABBIT. Th is WAS, AT BEST, A POOR EXPERIMENT SINCE THE RABBITS DID NOT HAVE A DISEASE ANALOGOUS TO THE HUMAN DISEASE, THEIR METABOLISM DOES NOT RESEMBLE HUMAN METABOLISM IN THESE REGARDS, SOME OF THE METHODS USED WERE A LITTLE LESS THAN ACCEPTABLE, AND THE DURATION OF THE EXPERIMENT WAS OPEN TO CRITICISM. FuRTHER WORK BY RlEDER HIMSELF AND AT LEAST TWO OTHER LABORATORIES DO NOT IN ANY SENSE CONFIRM THAT MAN BEHAVES THE WAY RlEDERS RABBITS SEEM TO BEHAVE. PRESENT EVIDENCE SUGGESTS THAT ORAL. Ca LCIUM Dis o d iu m Ve RSENATE WILL. INCREASE THE OVERmALL EXCRETION OF LEAD IN PATIENTS WITH A HIGH BLOOD LEAD AND NOT TAKE THE LEAD OUT OF THE ALIMENTARY TRACT AND PUT IT OUT THROUGH THE KIDNEYS. In THIS QUESTION OF FACT, OBVIOUSLY TIME AND THE PUBLICATION OF PAPERS WILL EVENTUALLY BRING US TO THE SAME POINT OF VIEW. In THE OTHER QUESTION OF JUDGE MENT, MORALS, ETC., IT MAY WELL BE THAT WE WILL CONTINUE TO STAND APART. I SHALL HAVE NO TROUBLE RESPECTING YOUR VIEW OR CONTINUING TO HAVE A GREAT FONDNESS FOR THE MAN WHO GENERATED THAT POINT OF VIEW. 1 SINCERELY HOPE YOU WILL FEEL THE SAME WAY. I HOPE ALSO THAT YOU FOUND NO CAUSE FOR UMBRAGE IN No r m Ka RRS LETTER. It HAS BEEN A LONG TIME SINCE WE HAVE HAD A QUIET EVENING TOGETHER AND l HAVE VERY PLEASANT RECOLLECTIONS OF THE ONES WE HAD BEFORE. I SINCERELY HOPE THAT SOME BUSINESS WILL BRING YOU TO L.OS An GELES AND ALLOW YOU A RESPITE TO PUT YOUR FEET UP AT OUR HOUSE. Wi t h k i n d e s t p e r s o n a l r e g a r d s , 1 a m, Si n c e r e l y y o u r s , GLM:me w "Ge o r g e L^../Ma i s o n tfe 0008520 March 30, 1955 Dr. George L. Maison Vice President and General Manager Riker Laboratories, Inc. P. O. Box 3157, Terminal Annex Los Angeles 54, California Dear Doctor Maison: A recent note from Manfred Bowditch, plus some previous comments that have come to my attention from other sources, have indicated that some of our colleagues believe or assume that my recent editorial in the JAMA was directed at your group in the Riker Laboratories. I should like to disclaim any such purpose or attitude on my part, for if I had had anything of that type on my mind, I would first have directed it to you. There may be others who believe that your group is open to criticism, and they may be right, in terms of the possible or potential effects of the promulgation of the broad use of the versenate for pro phylactic purposes, but that was not the point of my remarks, and i had and have no knowledge of any activity on your part that deserved my criticism. My purpose was and remains devoted to the discouragement of the use of any medical treatment of industrial workmen as a substitute for sound measures of industrial hygiene. None of us ha3 any justification for participating in any activity that will have that effect. I am so well acquainted with the lead trades and with the problems which they present and with the means by which these problems can be handled, that I said what I did without reservation and in the full knowledge that I am right, medically, morally and humanly speaking. I was directing my remarks at a group of industrial physicians, who through ignorance, insensitivity of social conscience, or sheer callousness to human welfare, are willing to pander to the wishes of uninformed or irresponsible industrial management. There is no present excuse for the continued existence of dangerous exposure to lead in American industry. Accidental and unfore seen absorption of lead will continue to occur in our complicated society, but satisfactory methods of controlling exposure to lead in the conventional lead trades of the USA are available and are being used by competent and responsible industrial organizations. This is what I was attempting,primarily, to say as simply and as directly as I knew how, and yam not at all happy at being thought to have been 0003621 N9766.01 Dr. George L. Maison - (2) - March 30, 1955 speaking to any other purpose. It is true, as I said, that the evidence for the use of the drug safely is not available, at least to me. But if it can be shown that it is entirely harmless, of itself, in this use, I am still bitterly opposed to such use to palliate the effects of hazardous exposure to lead in industry. Moreover, I know that if its prophylactic use is widely and unreservedly encouraged, even in justifiable situations for which no one is knowingly to blame, it will be employed as a justification for the medical protection of men who should have adequate environmental protection. This is a matter in which the consciences of medical men will have to remain sensitive, or we are in for a relapse in the present encouraging and much too long delayed application of sound standards and practices of industrial hygiene. I have felt that this statement of my position was due you and your asso ciates as well as due myself, in view of the personal and professional amenities which should prevail between us, and which I should like to preserve. Sincerely yours. RAK e Robert A. Kehoe, M. D. HE 000 vw O\ A. -r,*