CHOLOGEN
The proprietary Chologen is interesting some of our readers and several have sent us samples and literature. Dr. Philip Marvel, Atlantic City, N. J., for example, writes:
“By the way, I am to-day sending you by mail a package which the Council on Pharmacy and Chemistry may care to tackle, or it may not. I shall not be insulted any way, but since these chologen preparations are being used a good deal by various globe trotters, who sometimes hook up for a short stay here, I feel it might be of some interest to know ‘what fools these mortals be’ and how much the profession is being fooled with them.”
Chologen as a medical treatment for gall-stones has been before the German public for a number of years, and it is somewhat singular that so simple a method, which could be easily prescribed by the physician if it had merit, should exhibit such remarkable vitality in proprietary form in spite of evidence going to show that it rests on erroneous principles. The Council rejected it as an unscientific mixture. The treatment is somewhat liberal, consisting of the use, in varying successions, of three kinds of tablets: No. 1, calomel and podophyllin; No. 2, calomel, and No. 3, calomel, podophyllin, camphor and menthol. The proprietors tell us that the treatment should be proceeded with in spite of disturbances, such as diarrhea and pain in the abdomen, and that it should be repeated regularly in intervals for some years, so long as any trouble exists or recurrence is threatened. “A course” of Chologen tablets should be taken two or three times a year, No. 1 being given for ten days, then Nos. 1 and 2 for forty days and No. 3 for ten days.
It is worthy of note that experimental work seems to have been performed in the attempt to show that bile produced by this remedy will cause the disintegration and solution of gall-stones. Normal bile has a certain solvent action on gall-stones, but calomel and podophyllin have no demonstrable effect in increasing the amount of bile. We had imagined that these facts were generally known.
It is somewhat discouraging to reflect that some physicians entertain so low an estimate of their ability to prescribe such well-known remedies as calomel and podophyllin that they must use them in the fixed combinations provided by Dr. Glaser. If the self-respecting physician does not consider himself insulted by a proprietary manufacturer who presumes to tell him how to use such well-known remedies, this is a good sign that he needs to take a postgraduate course in materia medica and elementary prescription-writing. We feel that medical writers must be short of subjects when they devote papers to the exploitation of proprietaries consisting of these simple ingredients.—(From The Journal A. M. A., Feb. 1, 1913.)
HAGEE’S CORDIAL OF COD-LIVER OIL [AJ]
Fraud and Deception Connected with So-Called Cod-Liver Oil Preparations
The introduction of cod-liver oil as a supposedly easily assimilable nutrient and reconstructive was followed by its extensive use in wasting diseases, especially in phthisis, in the treatment of which it came to be considered almost essential, as it was supposed to possess some mysterious power different from that of other oils. Its unpalatable character led to various devices to render it tasteless and make it more acceptable to the stomach. Emulsions containing the oil in mixture with other substances were put on the market and served a useful purpose. But the oily nature, imperfectly concealed, was disagreeable to many, and gradually other preparations appeared which attempted to retain the supposed therapeutic virtues of cod-liver oil while dispensing with its disagreeable character. This attempt has been carried to the extreme that in many of the cod-liver oil preparations now on the market the oil has been entirely eliminated and all that is left of the oil is the name. This is a species of fraud which has been tolerated too long, but which will be kept up so long as physicians are willing to be duped. Some of these articles are said to “represent” the oil and to possess all its virtues. Others are said to contain oil, while still others are stated to contain “all the valuable constituents.” What is the standard by which we may determine the true value of these preparations and by which we may determine whether or not we, and through us our patients, are being humbugged?
A FOOD OR MEDICINE—WHICH?
Is cod-liver oil to be considered a food or a medicine? A food, certainly. As a food its value will consist in the fats it contains. These fats are more easily oxidizable and are considered more digestible than other fats because of the presence of compounds derived from the liver which favor its emulsification and enable it to penetrate the mucous membrane more easily than other fats. Aside from their nutrient properties we have no evidence that the fats of cod-liver oil possess any therapeutic value; if the oil possesses therapeutic qualities they must reside in its non-fatty constituents, and the activity of these non-fatty constituents is not acknowledged by those who have investigated them scientifically. Most pharmacologists believe that whatever virtue there is in cod-liver oil depends on its qualities as an easily assimilable fat.
On the whole, we must conclude with Cushny that “cod-liver oil has not been shown to have any action apart from that of an easily digested food, and its superiority to some other fats and oils has not been satisfactorily established.”
If, then, the value of cod-liver oil depends on the presence of fat as its nutritive constituent, the amount of fat a preparation contains will determine the worth or worthlessness of such a preparation; at all events, a preparation claiming to represent cod-liver oil which does not contain fat in some form is fraudulent.
HOW TO PROVE OR DISPROVE THE PRESENCE OF COD-LIVER OIL
Fats may be changed to fatty acids or to soaps, as occurs under the influence of pancreatic juice in digestion, and still retain their nutritive value, but it is not possible to manipulate them in any way so that they are still valuable as food, and yet do not respond to easily applied chemical tests which demonstrate their fatty nature.
Any preparation of cod-liver oil in which fat or fatty acid is not recognizable by proper tests is valueless as food, since its food value depends on the amount of fat or fatty acid present. An elementary knowledge of chemistry and the application of a few simple tests will enable any physician to learn for himself whether or not a preparation contains fat or fatty acids.
The preparations claiming to “represent” cod-liver oil are in liquid form, and if they contain oil it must be one of the following forms:
1. An emulsion of the oil which may be miscible with water, but from which the fat tends to separate and rise to the top. In this form the fat can be seen as globules under the microscope.
2. A solution, resulting from the saponification of the oil, containing a soap which usually will be alkaline in reaction, especially when mixed with water, and from which fatty acids are separated as a precipitate when the solution is acidified.
3. A solution of fatty acids. This will be acid in reaction and will be precipitated by the addition of water, in which the fatty acids are not soluble.
Hagee’s Cordial of Cod-Liver Oil
Hagee’s Cordial of Cod-Liver Oil Compound is said to “represent 33 per cent. of pure Norwegian cod-liver oil,” with other ingredients, in perfect solution. It is also claimed, according to the advertising pamphlet, that “in this preparation we have every beneficial constituent of the best and purest Norwegian cod-liver oil.” Put to the above three tests, however, Hagee’s cordial of cod-liver oil is not, 1, an emulsion of cod-liver oil; 2, is not a saponification of cod-liver oil; and, 3, does not contain fatty acids. It therefore contains no cod-liver oil. The only nutrients in the mixture, revealed by analysis, are sugar, alcohol and glycerin, none of which is contained in cod-liver oil.
In this case the manufacturer misleads by the use of the word “represents”; he is careful not to say “contains,” although the average reader would not be apt to notice the nice distinction. The manufacturer unwittingly admits that it contains no oil when he says that it “contains everything of value except the grease.” What else there is of value in cod-liver oil besides the “grease” we do not know. Certainly, if we estimate the value of the remedy by its nutrient properties, it must be set down as practically worthless, if not fraudulent, for although a mixture of sugar, alcohol and glycerin does possess certain nutrient value, the materials can be purchased for it far more cheaply in the open market. It is evident that claims are made for this preparation which cannot be substantiated.
Again, some of the so-called cod-liver oil preparations are termed extracts of cod-liver oil, but are not in fact made from the oil, but from the cod-livers instead. They are preparations which, if honestly made, might be worthy of trial, but they are improperly called “extracts” of cod-liver oil, since they do not contain the fat, which is the active constituent of the oil, but the extractives from the liver which may or may not possess therapeutic virtues. So far as we know, however, no satisfactory evidence is forthcoming to indicate that such extractives have any therapeutic value.
The attempt to modify cod-liver oil for therapeutic purposes may be pronounced a failure and the large variety and extensive sale of these preparations appear to be owing to the fact that physicians do not recall the ordinary facts of chemistry and fail to apply simple tests with little technical skill, but too readily accept as facts the statements of the manufacturers.—(Modified from The Journal A. M. A., Oct. 13, 1906.)
WATERBURY’S COMPOUND ONCE MORE [AK]
Most of our readers will remember what The Journal has published about a product that used to be sold as “Waterbury’s Metabolized Cod-Liver Oil Compound.” Briefly, it was shown by a report of the Council on Pharmacy and Chemistry and a contribution from the Association’s laboratory, that this “Cod-Liver Oil Compound” contained practically no cod-liver oil! Later the federal government declared the stuff misbranded.
The product is now sold under the name “Waterbury’s Compound.” It was recently stated in this department that “Waterbury’s Compound” was one of the proprietary preparations advertised both in “display” form and also in the form of an “original article,” in the Army and Navy Medical Record—a fraudulent publication that offered its editorial pages for sale. Physicians are now receiving from the Waterbury Chemical Company a reprint of what purports to be an editorial from the Army and Navy Medical Record entitled, “One of America’s Most Valuable Preparations.” The preparation, of course, is “Waterbury’s Compound.” The company in sending out this reprint also reproduces on the reverse side the title-heading of the Army and Navy Medical Record. All of which goes to show that some concerns not only do not mind being found in bad company, but seem proud of it. By the way, we wonder whether those physicians who are still prescribing this nostrum think they are prescribing a preparation containing cod-liver oil!—(From The Journal A. M. A., Nov. 15, 1913.)