ASptember,hi"l7.         Crucial  Test  of  Therapeutic  Evidence.  393 
presented  in  such  a  form  that  it  is  possible  to  tell  at  a  glance  whether 
or  not  they  are  based  on  demonstrated  facts,  which  could  usually 
be  verified  or  refuted  without  special  difficulty.  The  deductions 
are  usually  such  as  can  be  legitimately  drawn  from  the  data,  or  else 
they  are  obviously  absurd.  All  this  agrees  with  the  relatively  exact 
status  of  chemical  science. 
In  passing  to  data  and  deductions  from  animal  experiments,  a 
distinct  change  is  noticeable :  Not  only  are  the  data  less  reliable,  and 
less  worthy  of  confidence,  but  they  are  more  often  stated  in  a  less 
straight  forward  manner.  The  presentation  of  the  data  often 
shows  evidence  of  manipulations  of  the  results,  so  as  to  make  them 
most  favorable  to  a  preconceived  conclusion  that  would  recommend 
the  drug.  This  is  not  always  intentional,  but  is  partly  due  to  the 
less  exact  nature  of  animal  experimentation,  which  leaves  a  wider 
play  to  the  arbitary  interpretation  of  the  reporter.  A  certain  amount 
of  this  is  unavoidable.  No  serious  objection  can  be  raised,  pro- 
vided the  experimenter  presents  all  the  essential  data,  and  discusses 
fairly  all  of  the  interpretations  that  would  apply  to  them. 
On  the  whole,  it  is  usually  possible  to  form  a  fairly  definite 
estimate  of  the  value  of  experimental  data. 
When  one  comes  to  the  clinical  evidence,  an  entirely  different 
atmosphere  obtains.  When  the  Council  demands  evidence  of  the 
usefulness  of  a  remedy,  the  manufacturers  generally  respond  with 
every  sign  of  enthusiasm.  They  may  have  ready  a  series  of  articles 
already  published,  or  they  instruct  their  agents  to  bring  in  letters 
from  physicians.  The  last  method  seems  to  meet  the  most  cordial 
response,  judging  from  the  deluge  of  letters  and  opinions  that  floods 
the  Council. 
The  quality  of  the  published  papers  is  a  fair  reflection  of  the 
deficiencies  of  what  is  still  the  common  type  of  clinical  evidence. 
A  little  thought  suffices  to  show  that  the  greater  part  cannot  be  taken 
as  serious  evidence  at  all.  Some  of  the  data  are  merely  impressions 
— usually  the  latest  impressions  of  an  imperssionable  enthusiast — 
the  type  of  man  who  does  not  consider  it  necessary  to  present  evi- 
dence for  his  own  opinions ;  the  type  of  man  who  does  not  even 
realize  that  scientific  conclusions  must  be  based  on  objective  phe- 
nomena. 
Some  of  the  papers  masquerade  as  "  clinical  reports,"  sometimes 
with  a  splendid  disregard  for  all  details  that  could  enable  one  to 
judge  of  their  value  and  bearing,  sometimes  with  the  most  tedious 
