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LEAD I NDUSTRI ES ASSOCI ATI ON 420 Lexington Avenue New York 17, N. Y. MANFRED BOWDITCH D IR E C T O R O P H E A L T H A N D SA FETY July 1S$ 3H r a Thonas L* Shipoan :? * Los llamos Scien t ific Laboratory P# u* .o k 1663 .*.os Llanos* cw desdo ! \ \\ \ .ear fc e u / ^Xy . \ I f you iiavft 5iot alreae^r i t , I M inis you m i l f ia d i n te r e s t in th e *aily 12th nW*I* e d it o r ia l 4f<jtiioli &/djpfcy I s herewith* sebJ^eSoXB' l\y would not the new eo adriirsblo fcm a v&eroin you and those neeaad below could th e ^ le p s e ls in our midst th e soundest Itxafctevr on tiie n e rits at/&BSS3$$b\o l s ^ as i t develops? V? '/h ile 1 doub need remind you th a t t osubscribes to th e l*;,!*M** I hardly Ida k sca ttered h ith er and yon* rfcrthem* th e public %have one o f th large st c a l ouraal sY>--4a* i s surely sans reproche0 aid s s t Xh2^?h0 paM ) o f any non-national sodi on$pn?di you a r^ e o r p o re a lly on Bodqy Mountain tin , I know th a t your tccrfc a t i l t [tick's E aftero Standard* so* i f you think w e ll o f th is sugges tion* perh%3f you w ill yoske the lea d la gettin g i t under T#ay* Iti-^corely* r.iSiIcCiSc?suro ce* a-* Hardy Dr* Johnstone Br lehoe ' Sr* S te in e r t< 0014843 THE NEW ENGLAND JOURNAL OF MEDICINE July 12, 1956 EDITORIALS CURRENT THERAPEUTIC CONCEPTS I n the past decade numerous new drugs, drug com binations and therapeutic technics for the treatment of various diseases have appeared. These vary in value from the highly desirable to those of question able or no merit. Unfortunately, the volume of these therapeutic claims is so great that it is nearly im- possible for the busy physician to find time to study and evaluate them properly. Frequently, agents are introduced before there is much in the literature to support the claims made. Furthermore, many of the new substances or procedures are so complicated or so technical that special knowledge of the particular field is required ,to form sensible opinions concerning their values. As a result, a very undesirable situation has come into being whereby many physicians find themselves increasingly dependent on the claims of pharmaceutical-house detail men and the advertising that appears in such profusion in the medical journals and the mail. ' Undoubtedly, the highly ethical pharmaceutical firms, through their representatives and advertising, endeavor to make available all information about their products. They are also alert to detect any defects or toxic properties of their agent and to pass on this information promptly to the physician. Each firm, of course, endeavors to place its own products in the most favorable light and avoids, as a matter of policy, criticizing as inferior or rating as better a competitor's product even when such information may be available. . This, then, leaves it up to the physician to discover the actual truth on his own. He can do so in one of three ways, In the first place, he can spend enough time and effort to become proficient in the field and then read the literature on tiie particular substance or technic. Unfortunately, becoming proficient may require a review of basic science courses, such as pharmacology, and complete coverage of the litera ture may be equally difficult since much of the writ ten material may not be printed in the readily avail able journals. The physician can use the new drug or technic and decide about the merits pf the treatment by trial and error on his patients. This, of course, is highly unsatisfactory since it can be detrimental to the pa tients, as well as expensive, and, unless the treatment is frequently used, it may be nearly impossible to form a sensible opinion. Unfortunately, this proce dure is too often followed, leading to the widespread use of nearly worthless technics and medications. Under such a program, drugs with nothing more than placebo value can be widely accepted and used for long periods before the true picture becomes appar ent. Furthermore, such a procedure can be harmful both to the prestige of the physician and to the patient's welfare. A drug with inherent toxic proper ties may cause much damage before adequate knowl - edge is obtained by this type of study. Finally, there is a third way in which the physician can approach this perplexing problem. He can be very conservative about his use of new drugs and procedures until they are widely accepted among leaders in the medical profession and authorities in the special fields as evidenced by articles in the lead ing clinical journals and confirmatory studies by in dependent investigators. He can accept, as the best available opinion, articles prepared by the Council on Pharmacy and Chemistry of the American Medical Association and editorial articles appearing in the leading journals. Admittedly, this is the best pro cedure to follow, but, unfortunately, pressures are great, time limited, and needs urgent when thera peutic measures are considered. - There is, consequently, a most serious need for help in this field. The measures already carried out by the Council on Pharmacy and Chemistry and the many articles and editorials on therapeutic matters are excellent, but they are not always current and certainly there is not nearly enough of this type of writing. This situation has created concern in the minds of many. There have been many requests that an effort be made to give additional, up-to-date guidance in therapeutic matters. The hope has been expressed that some program or procedure could be established whereby information current among those with special knowledge in various therapeutic fields could be made available to those who are in urgent need of it. The Committee on advertising of the Journal has, during the past year, gained a great deal of experience in its dealings with the many new preparations, claims and types of information that are being pre sented to physicians everywhere. Consequently, it seemed to many that this committee was a logical group to undertake the task of organizing and main taining, with the help of a wide group of consultants, a column in the Journal in which current concepts of therapy would be presented and queries concerning drugs and procedures might be answered so far as possible. The first of these articles appears elsewhere in this issue of the Journal. HE 0014844