361 



data on medical experience with treatment ^Yas so voluminous that 

 no physician could reasonably be expected to maintain familiarity 

 with an appreciable fraction of new findings, nor to evaluate and inte- 

 grate the widely dispersed bits of fragmentary and partial data con- 

 cerning some particular drug in question. According to one authority, 

 ''The legitimate medical journals have multiplied like insects; one 

 must now seek his information from 5.000 journals (over 600 in the 

 United States alone) containing about 100,000 articles a year." More- 

 over, one general journal publishes 6,000 pages of advertising a year 

 and another medical specialty journal carries 1,300 pages. This au- 

 thority then comments that "Little wonder that few physicians have 

 the stamina to struggle with the overwhelming task of keeping abreast 

 of new developments through their own medical literature.'' - It was 

 indeed understandable that the tendency was reported for the medical 

 profession to rely on the data collected by dnig manufacturers respect- 

 ing new products that they were introducing, and that the chamiels 

 for such information included advertisements in medical publications, 

 brochures mailed directly to individual physicians, and visits to indi- 

 vidual physicians by traveling representatives ("detail men") of the 

 drug manufacturers. 



Traditionally, the physician has occupied a special and unique role 

 of community leadership, concerned with the general health of all and 

 the personal recovery of those who take sick. The ethical self-regula- 

 tion by the profession has maintained extraordinary standards and 

 has commanded general respect of the layman. Self-regulation has 

 extended not only to medical practice, but to standards of education 

 and training, supervision during apprenticeship, and to the mainte- 

 nance of quality standards of the tools and medicines used in medical 

 practice. To some extent, moreover, medical practitioners have entered 

 the drug manufacturing industry, serving in such essential activities 

 ■'s tpstmg of drugs, designing testing programs, establishment of 

 quality standards, and sometimes in the management of companies 

 and distribution of products. In consequence, the standards of ethics 

 maintained by the phj^sicians have tended to be transferred over to 

 the management of the ethical drug industry. Government interference 

 or regulation in the medical profession has been reluctant and tenta- 

 tive, partly because of the extent and quality of self-regulation by the 

 medical profession. To some extent, governmental regulation of the 

 dm g industry has also been inhibited by these same factors. 



By 1960, medical practitioners were being supplied with an 

 enormous volume of literature about new drugs and combinations of 

 drugs. Drugs were advertised to the profession by brand and trade 

 name, so that a single generic drug might appear under many names, 

 sometimes in slightly different form. Drugs underwent mandatory test 



- Charles D. Day. M.D. Dppartmpnt of Perliatriosj. CoUegre of Physicians and Surgeons. 

 Coltimbia University. N.T. "Selling Drugs by 'Educating' Physicians." Reprinted from 

 .Tournal of Medical Education. Vol. .SO. No. 1. .Tannary 1961. In U.S. Congress. Senate. 

 Committee on the .Tndiciary. Drug Industry Antitrust Act. Hearings before the Subcom- 

 mittee on Antitrust and Moriopol.v of the * * * Pursuant to S. Res. -"2 on S. 1.".52. A hill 

 to amMid nnd supplement the antitrust laws, with respect to the manufacture and dis- 

 tribution of drugs. ^'Tid for other purnoscs. R7th Cong. 3st and 2d sess. Parts: Pt. 1 . AMA 

 and :Medical .iuthorities. .Tnlv .5. r>. IS. 19. 20. 21. and 2.=>, 1961 : Pt. 2. AMA and Medical 

 Authorities fanpcndix) : pt. .3. Patent Provisions, Oct. 16. 17. l.«. .31. Nov. 1 and 9. 1961 ; 

 pt. 4, Pharmaceutical ;Manufa<^turers Association. Dec. 7. 8. and 9. 1961 : pt. 5, Government 

 Agencies and Organisations. Sert. 1.3. 1.^, Dec. 12. 1.3. 18. 19. and 20. 1961: pt. 6. Adver- 

 tising Provisions. .Tan. 30. .31. Feb. 1. 6. and 7. 1962; and pt. 7. Advertisincr Provisions 

 (appendixt. (Washington, U.S. Government Printing Office, 1961 and 1962), pt. 1, 

 pp. 959. 961. 



