XIV 



Chapter Thirteen — The Water Pollution Control Act of 1948: the dilemma Pare 



of economic compulsion versus social restraint 337 



I. Introduction 337 



The issues of national water pollution and pollution control. 337 



Evolving problems with water pollution in prewar years 340 



II. Postwar consideration of antipollution legislation 341 



Legislative proposals for water pollution abatement in 1947 _ 341 



Testimony in support of the water pollution control bill 343 



Industrial opposition to Federal pollution control 346 



Ambivalence of State and municipal views on Federal 



legislation 348 



Interagency contest over pollution control jurisdiction 349 



Summary of positions of groups for and against the legis- 

 lation 350 



Final congressional action on 1948 water pollution control 



bill 351 



III.T Gradual evolution of comprehensive pollution control 352 



National assessments of water needs and resources 352 



Resistance to amending legislation, 1954-55 353 



Passage of the 1956 amendments; presidential reservations. 354 



Renewed activity in Federal control legislation after 1960__ 355 



Significance of the 1948 act for subsequent pollution control. 356 



Chapter Fourteen — Thalidomide: The complex problem of drug control 



in a free market 357 



I.I^Introduction 357 



Medical and pharmaceutical ethics in a free enterprise 



economy 357 



Background of the thalidomide episode 358 



II. Criticism of ethical drug industry in antitrust investigation, 



1959-61 362 



Professional criticism of drug industry and drug control 363 



The need for strengthening of arrangements for drug 



evaluation 367 



Senate conclusions of drug investigation 368 



III.' Proposals to strengthen control of new drugs, 1961-62 369 



Improved drug information program of AMA 369 



Recommendations of the National Academy of Sciences 371 



Senate hearings on Drug Industry Antitrust Act 372 



IV. The thalidomide story 375 



Early evidences of thalidomide side effects 377 



Medical determination that thalidomide was associated 



with phocomelia 378 



Fortunate exclusion of thalidomide from U.S. markets 380 



The thalidomide testing program in the United States 381 



V. Congressional response to the thalidomide near-disaster 385 



Presidential interest in drug efficacy and safety 386 



The spate of drug testimony available to Congress 387 



Provisions of the 1962 Drug Act for increased Federal con- 

 trol 390 



VI. Aftermath of the thalidomide episode 391 



Implementation of the Drug Amendments of 1962 391 



Evaluation of efficacy, safety, and comparative merits of 



drugs 393 



The issue of generic versus brand name drugs; clinical 



equivalence 395 



Problems in the exchange of drug information 396 



Proposals for an authoritative drug compendium 398 



Report on biochemical mechanism of phocomelia from 



thalidomide 400 



VII. The continuing problem of securing and using scientific guidance 



on drug issues 400 



