398 



Altliough FDA, under existing- legislation, had been able to exercise 

 control over the advertising claims of drag producers, there had been 

 fomid no comparable form of control over the so-called "detail man" 

 who provided a linkage between the producers and the prescribing^ 

 physicians. The role of such detail men had come in for criticism in 

 the congressional hearings of 1960-62. While advertising could be used 

 as evidence, the verbal presentations of detail men to doctors were less 

 useful as evidence, and were presumably more subject to undetected 

 misrepresentation. As one critic expressed it: "There is no foolproof 

 method to scrutinize talks between a physician and a detail man, and 

 no law purports to try." This source concluded that there were two 

 alternative approaches to the problem of oral promotion, which is so 

 extensive that there is one detail man for ever}' 10 physicians in the 

 United States: 



Drug firms might be dissuaded from making any oral presentation about their 

 drugs whatsoever, thus confining all advertising and promotion to the printed kind 

 already strictly regulated by the Food and Drug Administration. Or Congress 

 could devise a system modelled after county agricultural agents, whereby govern- 

 ment exi)erts would be dispatched to doctors with dispassionate news about drugs 

 and with nobody's interest to serve but the public's. 



The difficulty with the imposition of Government regulation of this 

 kind, concludes this same critic, is that "unfortunately, detail men are 

 highly respected by doctors." They were considered in one survey of 

 medical opinion "the most informative source of data on drugs * * *." ^"^ 



Proposals for an authoritative dimg compendiu'm 



The extremes of attitudes toward drug information are suggested by 

 the attitudes reflected, on the one hand, in the decision of the New 

 York Hospital's pharmacological group to stock fewer than 500 

 well-tried drugs for all purposes, and on the other hand, by the 

 existence of an enormous range and variety of brands, increasing 

 rapidly with each passing year. Illustrations of the number and in- 

 crease are the existence of some 3,600 drugs (screened by the NAS-NRC 

 review), the addition to pharmacological resources of some 400 new 

 drug products a year, and the enormous numbers of variants of generic 

 drugs, such as the 140 different brands of reserpine, etc. Given such 

 an enormous volume of information about drugs, and the infinite range 

 of subtle responses of individual patients to various treatments, one 

 solution is to intensify pharmacological training of physicians.^"" An- 

 other approach is to reduce the "noise" in the system of drug informa- 

 tion (i.e., to improve the signal-to-noise ratio) by eliminating the eco- 

 nomic motivation for the dissemination of inaccurate or unreliable in- 

 formation about drugs. 



i"* David Sanford. The Dniff Peddlers. The New Republic. (Sept. 21. 196S). pp. 16-17. 



110 The Task Force on Prescription Drugs, second interim report and recommendations, 

 Aug. 30, 1968. devoted several pages to recommendations on improved drug information for 

 prescribing physicians, one of which, (p. vii and p. 65) was that the Department of Health, 

 Education, and Welfare should "* * * provide expanded support to medical schools, en- 

 abling them to include a course in clinical pharmacology as an integral part of the medical 

 curriculum." This should be followed by "continuing education to physicians on rational 

 prescribing." (U.S. Department of Health. Education, and Welfare. OflSce of the Secretary. 

 Task Force on Prescription Drugs. Second interim report and recommendations. Aug. 30, 

 1968. (Washington. U.S. Government Printing Ofiice. 196S)). 



