FALSE AND MISLEADING ADVERTISING (Prescription Tranquilizing Drugs) WEDNESDAY, FEBRUARY 12, 1958 HOUSE OF REPRESENTATIVES, LEGAL AND MONETARY AFFAIRS SUBCOMMITTEE The subcommittee met, pursuant to recess, at 10 a. m., in room 1501, House Office Building, Hon. John A. Blatnik, presiding. Present: Representatives Blatnik (chairman), Hardy, Meader, and Minshall. Also present: Jerome S. Plapinger, counsel; Eric Weinmann, associate counsel; Curtis E. Johnson, staff administrator; and Elizabeth D. Heater, clerk. Mr. BLATNIK. The Subcommittee on Legal and Monetary Affairs of the House Government Operations Committee will please come to order to continue hearings on possible misleading or false advertising by pharmaceutical firms in the promotion of tranquilizing drugs. This is in connection with the series of hearings dealing with the authority and responsibility and the operation of the Federal Trade Commission. This morning we have as our witnesses from the American Medical Association the present witness Dr. Leo Bartemeier, who is chairman of the council on mental health of the American Medical Association, past president of the American Psychiatric Association and director now of the Seton Institute in Baltimore. He is accompanied by Dr. Lauren A. Woods, associate professor of pharmacology, University of Michigan Medical School, Ann Arbor, Mich., and by Dr. Malcolm Phelps, of El Reno, Okla., president of the Academy of General Practice, practicing physician and member of the house of delegates of the AMA. So we will hear this morning from a psychiatrist, a pharmacologist, and a general practitioner. Dr. Bartemier, you are a psychiatrist and the principal witness. Will you please proceed with your testimony? At the opening, would you give a brief summary of your background and experience which you may later fill in in more detail for the record. To acquaint the committee members and the staff for the record now, just a brief oral summary of your professional field of interest or your specialty. 63 STATEMENT OF DR. LEO BARTEMEIER, CHAIRMAN, COUNCIL ON MENTAL HEALTH, AMERICAN MEDICAL ASSOCIATION, PAST PRESIDENT OF THE PSYCHIATRIC ASSOCIATION, AND DIRECTOR OF THE SETON INSTITUTE, BALTIMORE, MD.; ACCOMPANIED BY DR. LAUREN A. WOODS, ASSOCIATE PROFESSOR OF PHARMACOLOGY, UNIVERSITY OF MICHIGAN MEDICAL SCHOOL, ANN ARBOR, MICH.; AND DR. MALCOLM PHELPS, PRESIDENT, ACADEMY OF GENERAL PRACTICE, AND MEMBER OF HOUSE OF DELEGATES OF THE AMERICAN MEDICAL ASSOCIATION Dr. BARTEMEIER. Mr. Chairman, I am currently the medical director of the Seton Psychiatric Institute in Baltimore, which is a private nonprofit mental hospital, owned and operated by the Sisters of Charity of St. Vincent de Paul, and having approximately 250 patients, one-half of whom are under active treatment, the other half of whom are under continued treatment and care. As already noted, I am chairman of the council on mental health of the American Medical Association. I am a member of the National Manpower Council which is interested in the conservation of human resources, and I am a trained analyst of the American Psychoanalytic Association. My work for the past 3 years has been devoted to the teaching and the training of young physicians who were destined for careers in psychiatry. There is a period of 3 years of training which is required by the American Board of Psychiatry and Neurology for doctors who intend to become psychiatrists in approved mental hospitals. Our hospital is one of those. I have no prepared statement, Mr. Blatnik, but I am here as a representative of the American Medical Association to assist the committee in any way that I can. Naturally, we use these drugs, the tranquilizing drugs, mainly for the purpose of bringing patients into contact with reality so that we can then work with them in psychotherapy. Now by psychotherapy, I mean an investigation into the intimate and psychological problems of patients. These drugs make it possible for us to rather quickly, more quickly than we have previously, bring the patient in touch with reality. People who are confused, people who are severely depressed. Patients who are not tractable in the sense that they are so disturbed from within that they cannot control their behavior. Our experience has been that these drugs have very good effects. In our experience at the hospital, and I must say that I have only been there now for 3 years, having come from Detroit, Mich., where I was in private practice for a long time, these drugs have reduced the necessity of electroshock therapy for patients, and they have also reduced the necessity for insulin coma therapy. Mr. BLATNIK. Does that conclude your statement, Doctor? Mr. BLATNIK. Do you have any questions, Mr. Plapinger? Mr. PLAPINGER. Dr. Bartemeier, are you familiar with some of the writings and activity on the subject of the evils of advertising of tranquilizer drugs? Dr. BARTEMEIER. I do not think I am, sir. Dr. BARTEMEIER. No; I do not think I am. Mr. PLAPINGER. Are you familiar with the advertising? Mr. PLAPINGER. Dr. Kline told us yesterday, for instance, that the American Drug Manufacturers Association were drafting a code of procedures in connection with their advertising to the profession. He also adverted to a survey that the American Medical Association had underway to gage physicians' attitudes to advertising promotion. You are not familiar with those? Dr. BARTEMEIER. I do not think I am familiar enough with the survey to make any statements about it. Mr. PLAPINGER. Are any of the people who accompany you familiar with these? (No reply.) Mr. PLAPINGER. You are a member of the council of the American Psychiatric Association; do they have a journal? Dr. BARTEMEIER. The American Psychiatric Association has a journal; yes. Mr. PLAPINGER. Are there any advertising standards set by the association? Dr. BARTEMEIER. Well, I suppose that there are. I am not familiar with them. Mr. PLAPINGER. Are you familiar, by any chance, with an article that appeared in the Academy of Medicine of New York by Dr. Steele on the evils of, or misleading statements in, medical literature? Dr. BARTEMEIER. No; I am not; I do not recall the subject. Mr. PLAPINGER. Do you have any opinions on the type of advertising that has been addressed to physicians in connection with tranquilizers? Dr. BARTEMEIER. Well, I know there has been a great deal of advertising, of course. I have not been impressed with excessive advertising. It would be difficult for me, sir, to know what is excessive and what is not excessive. Mr. PLAPINGER. Are you familiar with the activities of the Food and Drug Administration in connection with some of the advertising of tranquilizer drugs? Dr. BARTEMEIER. No; I do not think I am. Mr. MEADER. Mr. Chairman, I would like to ask a few questions. Dr. Bartemeier, first of all, can you tell us how these so-called tranquilizing drugs actually function to produce the result of bringing the patient back to reality that you speak of? Dr. BARTEMEIER. Well, these drugs act through the central nervous system, and some of them act through the autonomic nervous systme. We know that the brain is the seat of our mental life, of our psychic life, and without the brain we cannot function. The brain, of course, is the central part and the most important part of the entire nervous system, and these drugs, apparently, act on the central parts of-have effects on the central parts of the brain, itself. Mr. MEADER. Do I understand, then, that we only know the results through say, empirical use of these drugs? We do not know the mechanics or the chemistry of the functioning of these drugs, what condition was wrong that was being corrected? Dr. BARTEMEIER. I cannot speak to that, but I think Dr. Woods could, perhaps, be of some assistance to the committee. Mr. MEADER. All right. Then I will pass to another question. As a practicing psychiatrist, do you receive, through the mail and otherwise, advertising or information from pharmaceutical houses concerning these drugs? Dr. BARTEMEIER. Oh, yes. Mr. MEADER. And their function, their efficacy, and all that? Dr. BARTEMEIER. We do. Mr. MEADER. Have you had any reason to doubt the accuracy of the representations made in this material that you receive? Dr. BARTEMEIER. I have not, so far; no. Mr. MEADER. You are not aware in the psychiatric profession of any complaints by psychiatrists that the claims made to them and the material sent by pharmaceutical houses are unreliable? Dr. BARTEMEIER. No; I have not. Mr. MEADER. You are not aware, then, of any widespread evil and misrepresentation of the function and efficacy of these tranquilizer preparations made to the medical profession? Dr. BARTEMEIER. No; I am not, sir. Mr. MEADER. And, in your official capacity as a representative of the American Medical Association, are you prepared to testify that the American Medical Association, as such, is not aware of any widespread abuse by the pharmaceutical houses in representing these tranquilizer drugs? Dr. BARTEMEIER. I cannot say that I know that, sir. Mr. MEADER. Well, now, your position is chairman of the American Medical Association council on mental health? Dr. BARTEMEIER. That is right. Mr. MEADER. If anyone in the American Medical Association were to know of misrepresentations and information sent by pharmaceutical houses to the medical profession with respect to these tranquilizer drugs, would not you be the one to know about it? Dr. BARTEMEIER. I do not think I would; not necessarily. Mr. MEADER. Well, are you aware Dr. BARTEMEIER. The function, the main function of the council on mental health, sir, of the American Medical Association, is to be of assistance to physicians in the application of the basic principles of psychiatry in the practice of medicine. This has not anything to do with drugs, you see. Mr. MEADER. But drugs are a part of your activity, are they not? Dr. BARTEMEIER. A minor part. Mr. MEADER. In health? Dr. BARTEMEIER. I would say a secondary part. You see, we are more concerned with what is mental; we are more concerned with those deviations from health which we ordinarily speak of as mental; that is, as psychic. We are far less concerned in our particular field with the physical aspects of medicine. Mr. MEADER. Well, now, let me ask you if you know if the American Medical Association takes an interest in and has any facilities for informing itself on the representations made by pharmaceutical houses to the medical profession, whether in the field of tranquilizer drugs or any other drugs? |