399 



Monitoring of drug advertisements by FDA may also be presumed 

 to have a beneficial effect."^ However, the achievement of all of these 

 goals — or approaches — rests ultimately on the concept that inf omiation 

 about drugs in medical practice can be systematically structured and 

 compiled. The concept appears to be that pharmacology, like all science, 

 is a matter of approximations toward reliability. Accordingly, it is 

 possible to conceive of a drug or pharmacological compendium that — at 

 any given time — presents the categories of most reliable information, 

 and indicates the range of uncertainties regarding less reliable in- 

 formation. This concept emerged early in drug practice in the United 

 States, with the development of the U.S. Pharmacopoeia. Interest in 

 it was intensified during and after the Kef auver hearings ; for instance, 

 in 1964, a review of the drug problem observed : 



Nor is there a single source book which supplies in concise, u.sable form per- 

 tinent information about drugs used and sold in this country. Information is 

 found in a number of publications with varying coverage, comprehensiveness, and 

 timeliness. Principal sources are: U.S. Dispensatory, Xew and Xonofficial Drugs 

 (AM A), Modern Drug Encyclopedia and Therapetitic Index, American Drug 

 Index, The Merck Index, Merck Manual, Physician's Desk Reference, American 

 Druggist Blue Book, Drug Topics Red Book, Accepted Dental Remedies, Unlisted 

 Drugs, The National Formulary, Pharmacopoeia of the United States of Ameri- 

 ca, American Hospital Formulary Service, and Drugs in Current Use. (The fore- 

 going list is cited in the text to the Commission on Drug Safety, a study sponsored 

 by the Pharmaceutical Manufacturers Association.) In general, the existing com- 

 pendia are lacking in much of the information pertinent to any si)ecific clinical 

 decision and at the same time contain much that is irrelevant to such decision. 

 One of the most widely used compendia is the Physician's Desk Reference which 

 contains solely information supplied by the pharmaceutical manufacturers. In 

 the case of new drugs, however, this information must contain the claims, warn- 

 ings, and contraindications approved by FDA."^ 



Accordingly, sentiment appears to be growing for action by the 

 Federal Government to sponsor publication of an authoritative and 

 objective drug compendium. Such a program was specifically requested 

 by President Johnson, in his special health message to the Congress, 

 March 4, 1968. Said the President, on this topic: "The very abundance 

 of drugs creates problems." When the consumer is a patient, he relies 

 on his doctor's choice of the appropriate drug. Yet, "the doctor is not 

 always in a position to make a fully informed judgment" because there 

 was no "complete, readily available source of information about the 

 thousands of drugs now available." Therefore — 



To make sure that doctors have accurate, reliable, and complete information on 

 the drugs which are available, / recommend that the Congress authorise this year 

 publication of a U.S. Compendium of Drugs. 



This compendium would be prepared by the Secretary of Health, Education, 

 and Welfare, in cooperation with pharmaceutical manufacturers who would bear 

 the cost of its publication, and with physicians and pharmacists. 



It will give every doctor, pharmacy, hospital, and other healtJi care institution 

 complete and accurate information about prescription drugs — use and dosage, 



"1 Dr. Philip R. Lee, Assistant Secretary of Health, Education, and Welfare and head 

 of the Task Force on Prescription Drugs, told the Nelson subcommittee, Sept. 26, 196S, that 

 doctors generally get "scant and insufficient" education in drug therapy while in medical 

 school and in private practice tend to make little use of "comparative, objective data." He 

 said that "many if not most physicians rely primarily" on the "advertising and promotional 

 activities of drug companies." (Cited in Morton Mintz, "Doctors Seen Ill-informed on 

 Drugs." Washington Post. (Sept. 26, 1968), p. A-3.) 



"2 Special analysis : "The Drug Safety Problem." Op. cit., American Enterprise Institute, 

 p. 21. 



