Medicine, University of Illinois, Chicago, Ill.; Dr. Albert H. Holland, Jr., head, Medical Department, Food and Drug Administration; and Commissioner Sigurd Anderson, Federal Trade Commission.

The hearing and the meeting for today is adjourned.

(Whereupon, at 1 p. m., the subcommittee adjourned, to reconvene on Wednesday, February 26, 1958.)

FALSE AND MISLEADING ADVERTISING

(Prescription Tranquilizing Drugs)

WEDNESDAY, FEBRUARY 26, 1958

HOUSE OF REPRESENTATIVES,

LEGAL AND MONETARY AFFAIRS SUBCOMMITTEE OF THE COMMITTEE ON GOVERNMENT OPERATIONS, Washington, D. C. The subcommittee met, pursuant to recess, at 10:05 a. m., in the hearing room, George Washington Inn, Hon. John A. Blatnik presiding.

Present: Representatives Blatnik, Griffiths, and Meader.

Also present: Jerome S. Plapinger, counsel; Eric Weinmann, associate counsel; Curtis E. Johnson, staff director; and Elizabeth D. Heater, clerk.

Mr. BLATNIK. The Subcommittee on Legal and Monetary Affairs of the Committee on Government Operations will resume hearings, and I believe the final day of hearings, on the Federal Trade Commission in connection with possible false and misleading advertising in the field of tranquilizers.

Our first witness this morning is Dr. Harry F. Dowling, head of the Department of the College of Medicine, University of Illinois, Chicago.

Dr. Dowling, we welcome you this morning. We appreciate your cooperation with the committee and the assistance you have given us. I notice you have a prepared statement, Doctor. Would you first give us a brief biographical summary of your background, your specialized professional field of work and your interest in this connection?

STATEMENT OF DR. HARRY F. DOWLING, HEAD OF THE DEPARTMENT OF MEDICINE, COLLEGE OF MEDICINE, UNIVERSITY OF ILLINOIS

Dr. DOWLING. Thank you, Mr. Blatnik.

I have prepared a biographical sketch here, but I might just say, just in brief, that I am a native Washingtonian, born here and obtained my doctor of medicine degree at the George Washington University in 1931. After that, after postgraduate work at Johns Hopkins and Harvard, I came back to Washington and practiced for 15 years, and at the same time was on the faculty of George Washington University. Then because of my interest in research and teaching, I took a full-time position at the University of Illinois, where I am

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now head of the department of medicine of the College of Medicine of the University of Illinois.

May I say that, of course, I am here as a citizen and not representing the University of Illinois. The opinions which I am giving are

my own.

May I turn this biographical sketch in?

Mr. BLATNIK. The full biographical statement will be placed in the record at this point.

(The statement reads as follows:)

BIOGRAFHICAL SKETCH

Dr. Harry F. Dowling was born in Washington, D. C., November 11, 1904. He received his bachelor of arts degree (magna cum laude) from Franklin and Marshall College, and his doctor of medicine degree (with distinction) from George Washington University School of Medicine. Upon completion of his residency and fellowship training at the Baltimore City Hospital, the Johns Hopkins University, and Harvard University, be became affiliated with George Washington University School of Medicine as instructor in medicine and director of central laboratory, eventually becoming clinical professor of medicine and chief of the George Washington medical division of Gallinger Municipal Hospital. In 1950, he came to the University of Illinois College of Medicine as professor of preventive medicine and head of the department. September 1, 1951, he was appointed professor of internal medicine and head of the department, and chief of medicine at the Research and Educational Hospitals, which is the University of Illinois Hospital and contains 750 beds.

The department of internal medicine is one of the major departments in the college of medicine. At present, approximately 285 physicians hold appointments in this department. Dr. Dowling is also a member of the staff of the Presbyterian Hospital of Chicago and the Municipal Contagious Disease Hospital.

Dr. Dowling's field of research has been concerned primarily with infectious diseases, included the methods of action of serum, sulfonamides, and antibiotics. He is the author of approximately 150 scientific articles, and has published books entitled "The Acute Bacterial Diseases; Their Diagnosis and Treatment" (W. B. Saunders & Co.) and "Tetracycline" (Medical Encyclopedia, Inc.).

Dr. Dowling holds membership in the American Society for Clinical Investigation, American Federation for Clinical Research, Phi Beta Kappa, Sigma Xi, Central Society for Clinical Research, American Public Health Association, Chicago Medical Society, is a fellow of the American Board of Internal Medicine. He was awarded the merit prize in medicine, particularly for his research in pneumonia, by the Washington Medical and Surgical Society, and also received the alumni achievement award from the George Washington University and an honorary degree of doctor of science from Franklin and Marshall College. Dr. Dowling is a member of a citizens' committee appointed by the Secretary of Health, Education, and Welfare to give advice regarding the activities and functions of the Food and Drug Administration (1955); member of Subcommittee on Infectious Diseases and Chemotherapy of the National Research Council (July 1952 to present), and associate member of the Armed Forces Epidemiological Board.

On the editorial boards of Antiobiotics and Chemotherapy, Antibiotic Medicine and Clinical Therapy, and G. P., the Journal of the Academy of General Practice.

Mr. BLATNIK. Will you please proceed with your statement, Doctor?

Dr. DOWLING. Well, Mr. Blatnik and members of the committee, I presume I have been invited here mostly because of a talk which I made as chairman of the council of the AMA, the section of the AMA on experimental medicine and therapeutics, in which I considered the fate of the drugs from the time when they were manufactured until they were actually taken by the patient. This was subsequently published in the Journal of the American Medical Association.

(See appendix, exhibit 12, p. 220.)

Dr. DOWLING. This is my first appearance before such a committee. It is not an accustomed role with me. I have been a practicing physician, and I am a full-time teacher and investigator at present, but, because of my work with drugs and because much of my investigation has had to do with the testing of drugs and antiobiotics-the sulfa drugs, for instance-I became considered with this intermediary period between the time when a drug is manufactured and when it is actually taken by the patient.

It is my understanding that this committee has for its function not the advocacy of certain legislation, but that you are investigating the broad field and that you are interested in finding out what could be done to improve any situations which might not be satisfactory in connection with the promotion of drugs, and it is under these circumstances that I am appearing here because I would like to cooperate in something like this.

I have submitted a mimeographed statement and, although it is brief, it might be a good idea if I would highlight it for the committee.

Mr. BLATNIK. Would you read the statement, Doctor? It is a short, condensed, concise, well-prepared statement.

Dr. DOWLING. I might say, first of all, that much of this committee investigation has been concerned with the advertising to the public, but in my remarks I am going to talk particularly about advertising to the medical profession, because I think this is an important field that should be considered in your investigation.

New drugs are being discovered, produced, and marketed at an ever-accelerating rate. In the 20 years ending in 1953, 182 new drugs were added to the United States Pharmacopoeia, which, of course, is the official compedium of drugs, while, in the 20 years ending in 1955, 742 drugs were added, or over 4 times as many. Even this does not tell the whole story, because many drugs are marketed under several different names, while others are slight modifications of existing drugs. The 1957 edition of the Physicians Desk Reference to Pharmaceutical Specialties and Biologicals lists over 6,300 brand names of products that are advertised only to the medical profession. This means that a doctor must keep up with a large percentage of these in order to be able to practice medicine well. At least, he has to be able to find out something about any 1 of these 6,300 brand names of products, and there are many more than these, that are advertised only to the medical profession.

Now, I should like to give a picture of the impact of the promotion and sale of this huge number of drugs upon the practicing physician. So-called ethical advertising is directed to the physician rather than to the layman. It is a fallacious, but nevertheless frequently repeated statement, that as long as advertising is directed to this professional group it cannot mislead them because they have enough knowledge to be critical of the facts presented. I shall try to give my opinion as to why this is not true. In the first place, fundamental knowledge regarding the actions and toxic effects of drugs is needed and this knowledge cannot be acquired by a practicing physician within a short period of time. Changes in medical treatment are taking place so rapidly that one method of therapy may be displaced by a completely different one in the space of a few years.