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Dr. BARTEMEIER. I think, so far as I would try to answer this question straightforwardly-and, to the best of my knowledge, I would say "Yes"--the first information comes from the pharmaceutical house that has developed it. To the best of my memory, this is the way I learned about these drugs in the first place.

At the same time, there were articles in our journals about experience of physicians with these drugs, and I tell you that they were doctors that I knew were very cautious about these things. I suppose a lot of people generally across the country are cautious about accepting new things. I mean we become accustomed to what is old and reliable and familiar and, when something new comes, they throw up certain barriers.

Mr. BLATNIK. In the scientific field, there is no problem on accepting anything new at once, once the scientific data and justification are proven and accepted. There is reliability in data substantiating claims of something new so, with confidence, they could use it, probably, and I would assume are eager to use a new, more advanced medicant.

Dr. BARTEMEIER. I only wish I had wider experience with these matters and that I would be able to help the committee more than I can with respect to instances of the one you have just described. But I don't have it.

Mr. BLATNIK. Are there any other questions?

Dr. Bartemeier and Dr. Woods, we thank you for your special effort in coming down to give us the benefit of your views and your experience in this inquiry which the committee is making. We thank you very much.

Dr. BARTEMEIER. It is a privilege to be here. I only regret I could not be more helpful to you.

Mr. BLATNIK. That is helpful-a contribution from one so eminent in service in your specialized field.

Dr. BARTEMEIER. Thank you.

(For material submitted later by the American Medical Association see appendix, exhibits 8A and 8B, pp. 191 and 193.)

Mr. BLATNIK. Our next witness is Dr. J. Murray Steele, chairman of the committee on public health of the New York Academy of Medicine, who is appearing here pursuant to subcommittee subpena.

The New York Academy, at the request of the commissioner of public health of New York City, conducted an intensive survey and study of the advertising of tranquilizing drugs.

The report of the academy observed that—

an additional aspect of the situation is the extravagant and distorted literature which some of the drug houses are distributing to the medical profession. Such literature may be misleading in two respects: First, it may recommend a product in such a way as to lead to, if not encourage, its indiscriminate use.

Secondly, some manufacturers' literature which is distributed to physicians and pharmacists contain, too infrequently, little or no mention of side effects and contraindications to the use of the tranquilizers.

Dr. Steele, please give us a brief, introductory summary of your professional background and your special field of interest and your present occupation.

25489-58-6

STATEMENT OF DR. J. MURRAY STEELE, CHAIRMAN, COMMITTEE ON PUBLIC HEALTH, NEW YORK ACADEMY OF MEDICINE

Dr. STEELE. My field of interest is internal medicine, chiefly chronic diseases. I am professor of medicine at New York University College of Medicine, in charge of their chronic disease research service.

I was chairman of the subcommittee on public health of the New York Academy of Medicine, with particular reference to the tranquilizer drugs, and that is my chief contact and knowledge of it. I have not followed through very well since then, and I am really not competent, in the way psychiatrists are, to talk about the use of these drugs.

The Academy of Medicine is in the habit of picking somebody who is, one might say, impartial or a layman to the subject to sit down and listen to the testimony of experts, and this report that I sent you contains my knowledge gained from sitting in that committee listening to the testimony of the experts.

(See appendix, exhibit 9, p. 196.)

Dr. STEELE. I would call attention to the date of that. That is more than a year ago, if I can speak for myself, and not as a representative of the academy, which this thing is, I could make a few remarks.

I do not know whether they would be helpful or not, or would you prefer to ask me questions?

Mr. BLATNIK. As a preliminary, Doctor, would you tell us just what the New York Academy of Medicine is?

Dr. STEELE. It is an organization to promote, well, let us say, that represents the various medical societies and has representatives from the various county societies of the State.

Its chief function is, really, the library, and holding a number of medical meetings of various sorts, the Harvard Society; the county society meets there in its section on medicine, and, if you will, it is an educational society for the medical community at large.

In addition, it has this rather powerful committee on public health that is often asked a great many questions, as we were in this case, from the commissioner of health, from the commissioner of hospitals, from Albany, with regard to certain practices, the value of certain drugs, and a variety of questions on which it tries to advise for State and community organizations of many kinds.

For instance, one example would be right now-they are making an enormous survey of the practices in blood banks, and they try to ferret out the practices that they think are not good and point them out to the community at large.

Mr. BLATNIK. You state you did not have any particular-not interest-but any record of experience in this psychiatric field. Could you identify some of the members of your subcommittee that presented this report on tranquilizing drugs to the whole committee on public health? Could you identify any of those as people with experience in psychiatry or chemotherapy?

Dr. STEELE. If you recollect Hubert Howe, who testified, he had some special interest in psychiatry. Cattell is a pharmacologist; Stephen Jewett, Ralph Kaufman, I believe one is a neurologist; the other is a psychiatrist Hewitt, and Boyd were in internal medicine. Mr. BLATNIK. Would you know, Doctor, what prompted the inter

est of the commissioner of health to request the study and report from the committee on public health?

Dr. STEELE. I think it was what was taken to be the wide and indiscriminate use of these drugs outside, for the most part, of the psychiatric institutions, and I think they believed at that time, and, perhaps, still do believe, that the kind and type of advertising had stimulated the use of these drugs in many, many situations where one did not think the stimulation ought to point.

For example, for schoolchildren at athletic games. It seemed to us that was a little bit of pressure put in, in places where drugs should not be used. I think that stimulated Commissioner Baumgartner to ask the academy to investigate their use.

Mr. BLATNIK. Dr. Steele, would you proceed with your statement now?

Dr. STEELE. The academy statement, or can I-you have read most of the important parts of that?

Mr. BLATNIK. Yes; we have.

Dr. STEELE. If I could just leave that and go to a few observations I made in preparation for this committee. It was not because of my particular interest, nor have I had a large experience in the use of these drugs outside of institutions, but one of the things that prompted Commissioner Baumgartner to ask us about this, and I would call attention again that this material by us was collected a year and a half ago; that, in 1956, I learned there were 99 cases of what was taken to be poisonings due to these drugs. It was very difficult to sort out whether these were suicide attempts or accidental. Two of them were fatal.

This year there are 170 cases, and no fatalities reported.

It is not determined whether those fatalities were directly due to the use of the drug, or whether it was something simply in connection. These patients were on ataraxic drugs at the time, and, not having access very much to the literature except as I collected and believe I have sent you some time ago, some of the examples we thought were excessive advertising, I did want to point out that I took the opportunity to go through the Physicians' Desk Reference.

It makes statements about the actions and uses and side effects of drugs, and is sent to a great many physicians in the community, and so I thought I should like to look through those and see what the advertisements were like in there-I should not call them advertisements; they are statements of actions, uses, and side actions of the drugs.

In the book for 1957 there were 20, and in the book for 1958 there were 41; so, the number of preparations has doubled, and the reflection of the increase in cases of poisoning may simply be due to the increased general use of the drugs.

did compare rather carefully, a large number of the advertising in 1957 as of 1958 for the actions and uses, and I think you could say, from the comparison of those two volumes, that the drug industry has certainly must have taken, perhaps this committee report, perhaps an editorial in the New England Journal of some 4 or 5 months agoI think they must have taken pains to eliminate some of their rather more fantastic advertising and to list side effects.

Comparing the two books, in a great many they had eliminated certain paragraphs that seemed a little objectionable, and they had in

serted in a great many instances the side effects that most people have come to know occurs with the drugs, and almost all of them seem to be pretty readily reversible, as was previously testified to.

I would like to point out that, many, many years before the invention of the word, ataraxics and tranquilizer phenobarbital was probably the tranquilizer of all times, and it is difficult to define these drugs because a great many of the preparations now have some of the new tranquilizers in combination with phenobarbital and some other barbiturates.

I think that is about all I have to say.

Mr. BLATNIK. Mr. Plapinger?

Mr. PLAPINGER. Doctor, at the time the study was made, was there any attempt to bring to the attention of the drug houses the excesses that you have complained of?

Dr. STEELE. We would not bring it directly to the drug houses. We brought that to the attention of Commissioner Baumgartner.

Mr. PLAPINGER. In that connection, in the last paragraph of your report you recommended that "the board of health survey this literature"-I assume this is the New York City Board of Health—“as the first step toward bringing about improvement in the situation so that there may be a more reliable guide to physicians." Do you know whether that was done?

Dr. STEELE. That, I know they did. Mr. Jerry Trichter, who is an associate in the department of public health, and from whom I obtained examples of advertising, has continued to review this literature. Whether it has been specifically brought to the attention of any of the drug firms, I do not know.

Mr. PLAPINGER. Do you know what the-what was the doctor's name? I am sorry; I missed that.

Dr. STEELE. He is not a doctor, it is Mr. Jerry Trichter, who is an investigator in this particular field, these particular fields.

Mr. PLAPINGER. Do you have any knowledge of Mr. Trichter's findings?

Dr. STEELE. No. I know that he has continued to accumulate various kinds of literature but I do not know what sort of action he has taken or whether he would agree with my position that the advertising, the statements about their actions seem to be improving.

I was just going to say, I think this is one of the things that happens every time a bunch of new drugs come out.

There is all of a sudden this great enthusiasm; I am not sure that the drug firms are entirely to blame. It is just something that goes on at the moment, and the advertising section or the publicity section of the drug house may get ahead of its directors now and then.

This certainly was true of the antihistaminics, it may be true to a certain extent with the antibiotics, when they burst on the world and then they settled down, and I think that is what they tried to do in the past year with what little information I have.

But I am still convinced and would stick by this statement of the academy that there was somewhat unreasonable advertising for a wide variety of conditions. I suppose it depends a little on your philosophy as to whether you think you ought to eliminate anxiety entirely from our life, and I would suspect that a little anxiety here and there was a good thing.

Mr. PLAPINGER. With reference to the Bulletin of the Academy of Medicine, do they pass on advertising content before it is included in the magazine?

Dr. STEELE. Yes.

Mr. PLAPINGER. Is there a special committee of the academy?
Dr. STEELE. Yes; I think there is.

Mr. PLAPINGER. To your knowledge, have there been any recent occurrences, recurrences of the sort of thing that you complained about in your article?

Dr. STEELE. None of the things we complained about were ever published in the bulletin of the Academy of Medicine so far as I know. Mr. PLAPINGER. I see.

Have there been any instances elsewhere that have appeared to your knowledge?

Dr. STEELE. Being a teacher full time and under the same difficulties stated before, I do not see the current literature sent around to doctors very often on these things, and since it is not my chief concern, I have not followed through on these incidences of advertisements since the time I sat and listened to the experts of the committee. My only way of getting at it was really to pick up my two desk references and compare them and those seem to me to be improved. Mr. MINSHALL. Will the gentleman yield?

Mr. BLATNIK. Mr. Minshall?

Mr. MINSHALL. Doctor, you mentioned a list of different kinds of drugs. I did not quite understand it. You said it increased from twenty to forty-some in 1957-58.

What is that list and who publishes it?

Dr. STEELE. There is a book called The Physician's Desk Reference. Mr. MINSHALL. The Physician's what?

Dr. STEELE. Physician's Desk Reference.

Mr. MINSHALL. Yes.

Dr. STEELE. And it lists drugs under various categories, alphabetically, by drug house, by its actions and uses, and under that, there is a heading "Ataraxics" which I understand comes from the old Greek word meaning free of passion, undisturbed in mind, and the second definition, the Oxford English Dictionary gave was "stoically and indifferent." [Laughter.]

That is the term that is technically used for these tranquilizing drugs and it is as ataraxics that these drugs were listed and the number of preparations has doubled in 1 year from 20 to 41.

Mr. MINSHALL. You mentioned some examples of people being poisoned by some of these so-called tranquilizers-what was the poisoning effect?

How does it affect the patient?

Dr. STEELE. Apparently mostly drowsiness, running into coma, something like that, and they gave them stimulants and all of them recovered, 177 in the past year, and 2 seemed to have died although the evidence from the medical examiner's office is not clear that it was the drug that actually killed them.

They were simply on the drug and that was all the information he had.

Mr. MINSHALL. In your experience, Doctor, what other side effects, dangerous side effects, have you noticed from these drugs?

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