of copyright and the doctrine of right to privacy. I would like to submit Mr. Chapman's paper as exhibit 3 since it cites legal precedents.

Mr. BLATNIK. Without objection, it is so ordered.

(See appendix, exhibit 3, p. 176.)

Dr. KLINE. I had meant, incidentally, to submit the editorial I referred to before as exhibit 4.

Mr. BLATNIK. You may do that now.

(See appendix, exhibit 4, p. 181.)

Dr. KLINE. I got so fired up by Mr. Chapman's letter that I immediately phoned him and obtained permission to quote him.

I have reviewed and considered at great length various alternative proposals such as making it mandatory for the individual being quoted to clear the "copy" in all cases prior to publication. None of these appear to be practical and would consume a tremendous amount of time involving the investigator and clinician involving himself with matters which are not germane to his work. Clearly though, if legal recourse is available and this is brought home by a court action there would be very little chance of the same error being repeated. Actually such a drastic measure would probably be unnecessary. My suggestion would be that in those cases where the investigator feels that he has been quoted out of context or in such a way as to misrepresent his real views, that he write to the pharmaceutical house involved requesting that a retraction or an amended statement be printed by them in the same mediums in which the original claim was made. If for any reason the pharmaceutical house were unwilling to do this a letter to the journal of the American Medical Association or the American Journal of Psychiatry detailing the correspondence would certainly produce an effect that would forestall another error.

Mr. PLAPINGER. You referred to the mechanisms to correct quotations out of context.

Dr. KLINE. Yes, sir.

Mr. PLAPINGER. These mechanisms have always existed. Isn't that so?

Dr. KLINE. Yes, but I think there has not been an awareness that they did exist on the part of the people who felt injured by being quoted out of context.

I think one of the useful functions of the hearing may be that it will bring to attention mechanisms whereby this can be corrected under already existing laws.

Mr. PLAPINGER. It would seem to be almost a reflex action that if you, as a scientific author were quoted out of context, you would write to the medical journals, and possibly as a last resort, have recourse to the courts. But this is time consuming, and what happens in the interim with respect to the publication of the quotation out of context?

Dr. KLINE. You in a sense have very nicely anticipated what I wanted to say, which I am happy about, because it must be sound thinking if this is your way of reasoning.

I have reviewed the various alternate proposals, which I won't go into to save time, but none of these appear practical.

I think, as you have pointed out, that recourse to the courts probably is unnecessary. My suggestion would be that in those cases where the investigator deems that he has been quoted out of context or in such a

way as to misrepresent his real views, that he would write to the pharmaceutical house involved, requesting that a retraction or an amended statement be printed by them.

Once this happened, I think that the rest of the pharmaceutical industry would be extremely reluctant to get embroiled. I'll have in a moment an illustration of a company which did something which some of us did not consider particularly ethical. In fact, it didn't involve psychiatrists. It involved science writers. They did exactly this. They (the science writers) wrote a letter to the American Journal of Psychiatry, which was published, and they did not name the company but

Mr. PLAPINGER. Was this a quotation out of context?

Dr. KLINE. No, this was a public relations stunt which involved a misrepresentation of fact.

Mr. PLAPINGER. Can you tell the committee something about that, without mentioning the name?

Dr. KLINE. Surely, it is in the literature, so I would have no hesitation.

What they did was invite the science writers to a big shindig to hear about the discovery or invention, and the results of a new product of theirs. I think I am not sure of this, but I think that they offered to pay expenses and so on to this meeting of the science writers.

At the same time, they sent letters to the medical profession, particularly the psychiatrists, stating that because of the tremendously exciting new results that had been found with this drug, if information about this appeared in the press prior to the physicians being supplied with all the data they wanted to apologize, but it was because the science writers were so excited about the drugs that they couldn't restrain themselves. This, of course, threw into question the ethics of the science writers, and was very much contrary to the fact.

This was a number of years ago.

The secretary or the president-I have forgotten who it was-of the science writers

Mr. PLAPINGER. How long ago was it?

Dr. KLINE. I would guess about 2 years ago. Dr. Ayd would have the exact date.

Mr. PLAPINGER. I wanted the record to show that. It is almost 2 years ago to the day.

Dr. KLINE. They wrote a letter of protest which certainly received a great deal of attention. There has been nothing even remotely resembling this kind of a public relations stunt since. They were burned, but bad.

Mr. PLAPINGER. This was no marginal operator, either; it was a fairly substantial firm?

Dr. KLINE. That is correct.

In the editorial which I would like to submit as exhibit D, this is one of the things I pointed out. The incident was a very effective means of putting an end to this sort of thing. They were in the doghouse with the rest of the industry; they earned themselves no good will from psychiatry, and it threw into question even the value of the drug, because if it had to be promoted by such a method-and not only that drug, but other products of theirs. So they were burned, and no pharmaceutical house has attempted anything even remotely resembling it since.

I think with the problem of being quoted out of context, all that would be required would be one investigator saying, "I demand that you print a retraction in whatever literature has appeared." This would leave the pharmaceutical house in an embarrassing position, because they would have to come out and say, "We have misquoted so and so."

If they didn't do it, a letter to the medical journals would, I think once and for all, end any business along this line.

In point of fact, you are going to have trouble finding a pharmaceutical house today that is willing to do this. They are very much aware that the few of them that did indulge in excessive promotion gained nothing by it except a good deal of hostility. So that in order to carry this through, you are going to have to find a pharmaceutical house which is stupid enough to go back to an advertising promotion device which has not turned out to be particularly successful.

I'll save my other points, if I may. I know you want to get along. As you point out, legal recourse is still available, and I think probably the legal council for the American Medical Association would undertake this if it were necessary. But I am reasonably certain that it would never become necessary.

The second criticism is that there exists a general belief among those not better informed, that pharmaceutical houses are constantly pressuring an investigator to provide positive results.

During the past 3 or 4 years we have had dealings with more than a dozen pharmaceutical houses and have never found this to be true. When a drug is in the investigational stage prior to marketing there is literally no one more anxious to find out what the limitations in respect to both action and undesirable side effects may be than the pharmaceutical house producing the preparation. This would be true for economic reasons if for no other since if a drug is not as potent as some other available preparation it will not stand up to competition on the market and if there are undisearble side effects it would entail not only the loss of the firm's reputation in respect to the particular drug in question if these are not brought to prior attention but would tend to throw question on their other products as well.

In other words, if they say, "This is the best tranquilizer since Adam," or something like that, and then it turns out to be ineffective, it throws into doubt their claims as to other drugs. So that if a drug is no good in the investigational stage, they are very happy to know about it. It isn't that they like to hear that it is no good, but they have to know whether it is not good, or they are going to go broke very shortly.

Instances of this sort are undoubtedly well known to this committee, to the medical profession and the pharmaceutical industry at large. Despite substantial grants-in-aid to support investigations the pharmaceutical house is grateful to know as soon as possible that a drug is not suitable for marketing since this saves many hundreds of thousands of dollars in terms of further investigations, promotion, and so forth. Mr. PLAPINGER. Dr. Kline, in your editorial (see appendix, exhibit 4, p. 181), you mention that it would be improper that attempts be made to suppress an article containing an unfavorable report, which is somewhat related to pressure on the investigator to obtain positive

results.

I can't tell from the text of the article whether this is an exising evil, or whether this should not be done in any event.

Dr. KLINE. I think there purportedly was one attempt to do this, which may have been a misinterpretation on the part of the parties concerned. It was not that the pharmaceutical house called up the investigator and said, "We'll give you $250,000 not to publish your article." It is a beautiful thought. The sort of thing that happened was that the investigator submitted the paper for publication and there was a long delay before it appeared, and he had to write and insist that it be published. This is very easily subject to misinterpretation. Good researchers are usually paranoid individuals in any case, or they wouldn't be in research, and they have to be constantly critical of themselves, and their work, and therefore it is pretty hard not to be critical of others.

I can use as an illustration a paper which was accepted 2 years ago for publication in one of the psychiatric journals. The editor happens to be a friend of mine, and he wrote that he was going to give it early publication. It is not a particularly brilliant or new article. It is a summary kind of article, with a slightly different twist. It has now been 2 years, and the article hasn't appeared. As a point of fact, it says nothing unfavorable. I think the pharmaceutical house would be just delighted if it were published. But there are long delays in publication. There may be other priorities; there may be all kinds of things that interfere. It is sometimes not difficult to interpret a delay of this kind to be a malicious intent on the part of a pharmaceutical house, particularly if it is an unfavorable article.

I am giving an illustration of a paper that is quite laudatory, but it has still taken 2 years to get it into publication. It should be out next month, but we have been told this before.

My own suggestion would be almost the opposite. I think it would be helpful for an investigator to send a copy of his proposed manuscript to the pharmaceutical house. I have done this on many occasions when I wasn't sure of some of the literature, and they are very nice about supplying you some of the bibliographic references, and so on. They are very good in picking up errors of fact or references you have overlooked. I have never seen an attempt to get you to change your conclusion or manner of statement, and so on. So that, rather than an evil, I think it would be in many cases quite useful, since no one can keep up with the tremendous flood of literature on all of the drugs, and a pharmaceutical house obviously is in the best position to know what publications are out in this field, and they can sometimes save you from making a pretty bad error.

Mr. MEADER. Dr. Kline, I was interested in your editorial and especially in the phrase on the last page, "Leaking of information to the press."

Do I gather you don't think that is a very good thing to do?

Dr. KLINE. No; not particularly. This is one of the things that I think has also decreased. I feel that by and large an article either should be presented at a scientific meeting, or appear in a journal before it is extolled to the skies. I think once it has been presented at a public scientific meeting, it is then fair game for anyone who wants it.

What I would object to is bringing the press in before the drug has been announced, or before the scientific paper has been given, and

giving them the "lowdown" on the thing without the request that they hold this off until the paper itself is entered. I think it is legitimate to give it to them prior to the meeting, as long as their deadline is observed.

In fact, it sometimes serves a very valuable purpose, and in one case, we requested a press conference in New York City because the drug we were introducing was potent and dangerous, if not used properly. The meeting itself where the paper was to be presented was not in one of the great urban centers. In all probability, if we had not had such a conference, someone from the local press might have shown up and. the paper would not have been reported fully-that is, in respect to the cautions which have to be observed, and somebody reading it--even a physician-might then attempt to give the drug without the proper awareness of the danger. In these circumstances the conference serves useful purposes.

Mr. MEADER. In other words, this technique of making information available by leaking might more likely lead to a distorted picture than if it were done as you regard a proper way, after the proper steps were taken to insure that the entire picture be presented at one time?

Dr. KLINE. Yes, I would say it would be highly desirable that the investigator whose work was being leaked to the press-let's change it because in this case it wouldn't be "leaking." If they wanted to prepare the press that in 2 days or a week, this paper was being presented, I think the investigator whose work is being quoted should be present. If I may, I'll read one paragraph, jumping ahead, on the subject of the science writers. The misconception that if you give a science writer a meal and a few drinks, he will give a favorable description of a paper or an article, dealing with one of their products is what I have in mind.

This is so far from being correct that it verges on the ludicrous since if there exists a more skeptical group of pros, hard bitten and ungrateful I have never heard of them. Gruelling by a colleague is polite and diluted compared with the cross-examination of a doubting science writer and it is further the habit of these nefarious creatures to seek out one's worst enemies to provide questions and criticisms which the enemies themselves would consider it unpolite to ask. On those occasions when the press bring to public attention in glowing terms a product that subsequently does not live up to its initial expectations it is usually when a reputable investigator goes off the deep end taking others along with him or alternately when the reporting is done by a writer inexperienced in the scientific field where his lack of adequate background and experience have led him into making foolish but honest mistakes, which is, Mr. Meader, why I think that the press conference does, on occasion, serve a very useful purpose. I have undergone some of these grillings by science writers, and they are merciless. They question your ancestry and your work and everything else. So that, again, the evidence in this article we referred to is that they have a very high professional pride in what they are doing, and they didn't like being taken as they felt they were.

In this case, instead of stewing about it and doing nothing, they took quite direct action, which was extremely effective.

Mr. PLAPINGER. Actually, the incident occurred in February. When was the publication?

Dr. AYD. June 16, 1956.