Regulating Medicine

REGULATING MEDICINE

The Pure Food and Drug Act

The Pure Food and Drug Act passed by Congress in 1906, in part as a response to muckraking reporter Samuel Hopkins Adams's exposés in Collier's Weekly, did not have as great an effect as was hoped on the patent medicine market that Adams estimated to be worth $75 million a year. While the law discouraged the adulteration of foods and drugs and the misrepresentation of claims on labels and also led to somewhat improved sanitary conditions, it directly affected only the most brazen abuses. It did not call for the reporting of all ingredients, except in the case of narcotics; it only banned statements on the label of a drug about its composition that were "false and fraudulent." The 1906 act also did not apply at first to claims about the effectiveness of drugs or to statements made in newspaper advertisements. Unintimidated nostrum manufacturers believed the existence of the act would lead consumers to think that whatever was sold had received some form of government approval.

Amendments to the 1906 Act

The 1906 law did not cover cosmetics, obesity cures, the newer habit-forming drugs, or curative devices of a mechanical nature. In 1910, for example, Albert Adams could market his "spondylotherapy" cancer treatment with impunity. Adams sold an electrical "dynamizer" on which a patient was directed to deposit a drop of blood. To effect a cure, the cancer sufferer was to place an electrode from the dynamizer on the forehead of a healthy person, who was then to face west in a dim light. Such continued quackery quickly revealed the limitations of the original law, and further legislation was approved. In 1912 the Sherley Amendment changed the federal law to cover fraudulent claims of drug effectiveness, but it burdened the government with the task of proving such claims false and fraudulent, and the law had little effect. Other legislation included the Gould Amendment of 1913, which required quantity labels on packaged goods.

The Role of the AMA

The American Medical Association (AMA) played an important role in the battle to exercise control over the patent medicine market. Its Council on Pharmacy and Chemistry published Adams's articles from Collier's Weekly in a booklet and by 1911 had distributed 150,000 copies around the nation. The editor of the Journal of the American Medical Association firmly stated in 1912, "there is no such thing as an unobjectionable 'patent medicine' advertisement in a newspaper." Despite the loss of a lucrative source of income, many newspapers began to censor patent medicine advertisements, forcing many patent medicine manufacturers to give up their fraudulent claims. By 1915 the Pinkham company, fond of marketing its goods to women suffering from "female complaints," had stopped referring to the prolapsed uterus in its advertising. The AMA suggested that Pinkham's labels might just as usefully read: "For Those Who Like This Sort of Thing, This is the Sort of Thing That Those People Like."

MAIL-ORDER "BABY KILLERS"

Every year the American public spent between $75 million and $100 million on medical frauds, many mail-ordered by women. Many of these nostrums were aimed at children and sold as teething "sirups," sweet powders, cough killers, croup remedies, "children's comforts," and "babies' friends." They depended for their effectiveness on alcohol, opium, morphine, and/or chloroform. Used to excess on a fussy child, they killed outright; even in moderation they could gradually become addictive. The United States government investigated seven of these widely advertised drugs but could not legally prevent their sale. All it could do was make the manufacturers take the word "harmless" from the labels and tell the public about the quantity of opiates contained in these "baby killers." The manufacturers responded by substituting for the familiar morphine and chloroform equally dangerous drugs such as codeine and heroin that were less well known. In 1913 all of these "sirups" and similar concoctions were still on the market.

Source:

Edith Rickert, "The Meanest Business in the World: How Many Sick Women are Tricked," Ladies' Home Journal, 30 (September 1913): 10+.

Foreign Drug Monopolies

The AMA council also criticized the high cost of certain drugs. It was especially critical of the Bayer Company, a German firm that was the original producer of aspirin, or acetylsalicylic acid, an easily manufactured chemical. The Bayer Company's exaggerated advertising claims for "Aspirin-Bayer" led the council to banish it from New and Nonofficial Remedies, its annual volume for physicians containing carefully documented information about drugs. In 1917 the AMA tried to prevent the Bayer Company from renewing its patent on aspirin, which had given the company a monopoly on the manufacture and sale of acetylsalicylic acid in the United States. Partly as a result of the AMA disclosures, the Bayer patent was not renewed in 1917, and other drug companies were able to enter the aspirin market.

The Demise of the Patent Medicines

As public opinion shifted and the new laws gave physicians more authority, the patent medicine companies slowly gave in to the medical profession. The AMA's own regulatory system extended the federal effort to control drugs while also shifting drug purchasing from purely an individual choice to one contingent on the recommendation of the physician. The campaign against patent medicines continued to build the confidence and authority that the medical profession had begun to gain in the Progressive Era. But consumers would still need to wait for a further law, the Pure Food, Drug, and Cosmetic Act of 1938, to expand federal protection over many other harmful items.

Sources:

James Bordley III and A. McGehee Harvey, Two Centuries of American Medicine, 1776-1976 (Philadelphia: W. B. Saunders, 1976);

James T. Patterson, The Dread Disease. Cancer and Modern American Culture (Cambridge, Mass.: Harvard University Press, 1987);

Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982).