GARDNER’S SYRUP OF HYDRIODIC ACID
Report to the Council on Pharmacy and Chemistry
The following report on Gardner’s Syrup of Hydriodic Acid was submitted to the Council by a subcommittee:
This product was first taken under consideration in February, 1906. Reference to several committees was necessary, on account of the peculiar claims for the pharmaceutical, and especially the therapeutic, superiority of this preparation. At this time, as the Council did not have the necessary facilities for investigating therapeutic claims, the product was approved by the Council.
Since this time, however, the manufacturers have laid especial stress in their advertisements on some highly improbable claims, stating, for instance, that this Syrup of Hydriodic Acid possesses “all the advantages, with none of the objectionable symptoms caused by potassium iodid, or other forms of iodin medication.” To one with even an elementary knowledge of chemistry, the absurdity of this statement should be evident. The alkaline reaction of the tissues makes it impossible that hydriodic acid should persist as such in the body. In fact, the iodin must circulate in precisely the same form, whether administered originally as potassium iodid or as hydrogen iodid. The qualitative identity of the therapeutic actions is further proof of this fact, were such needed.
Since the most important objectionable symptoms of iodid medication arise after the absorption of the drugs, and since hydrogen iodid is conceded to be readily absorbed, it is evident that these symptoms must be equally liable to occur with hydrogen iodid as with potassium iodid, provided that equivalent doses of iodin are administered. An apparent difference in clinical results would arise if one drug were habitually given in smaller doses than the other. Since, however, the iodin is present in the body in precisely the same form, whether it is administered as a hydrogen iodid or potassium iodid, it is evident that a given degree of therapeutic effect would correspond to an identical tendency to iodism, whichever drug was used. If, as appears to be the case, the use of hydriodic acid is commonly restricted to those cases in which only minimal doses of iodin are required, the relative infrequency, or even absence of symptoms with such doses would not prove that the drug itself is less apt to cause them than is the potassium salt.
These facts are in reality self-evident; but since the Council now has proper facilities for obtaining the views and experiences of clinicians, it voted to submit the statement in question to its staff of clinical consultants, and to be guided by their advice.
OPINIONS OF THE CLINICAL STAFF
The following is an epitome of the replies of the eleven members of this staff who had used the article or who expressed an opinion to the questions sent out by the Council:
1. Query: “Do you think it possible that such a preparation could be devoid of the usual effects of iodin preparations?”
Eight reply that they consider this, a priori, impossible; three stamp the statement as highly improbable, but do not care to say that it would be impossible. One of the correspondents remarks: “While distinctly taking the position that under many conditions we must accept clinical results which we find not explainable by our theoretical knowledge, where the conditions are so simple as in this case and where we know that the iodin, whether administered as hydrogen iodid or potassium iodid, must behave in the same way, after absorption, I believe that no properly educated and correct thinking physician can or will, after due consideration, fail to reject the claims of superiority made by the proprietors of this preparation.”
2. Query: “Would you consider it necessary to make clinical experiments to settle this question?”
Seven of the correspondents consider this superfluous; four of these have had some experience with the article. Four, who have not used this product, consider a clinical test advisable. Under Query 3 we discuss the results of such tests.
3. Query: “When using Gardner’s Syrup of Hydriodic Acid, have you ever noticed from it any of the objectionable effects of iodin preparations?”
Six of the correspondents have not used it, or are uncertain whether or not they used the product made by Gardner. One correspondent remarks: “Never used it. Repelled by claims of superiority which exaggerate disadvantages of potassium iodid and overlook the small amount of iodin used in the preparation advertised.” The five clinicians who have prescribed the preparation report as follows: 1. Objectionable iodin effects in two cases, both patients being intolerant of all iodin preparations. 2. Has only prescribed it once or twice, but thinks he has seen iodism in one case, some years ago; does not recall clearly. 3. No; but has used this make very little, and then always in very small but continued doses. 4. No, always used it in small doses. 5. Yes, several cases in children; typical coryza, etc., with doses of three drams three times a day.
Conclusions: It appears that typical iodism occurred in several cases, after doses corresponding to 10 grains or less of potassium iodid per day, and this is a rather limited clinical material. Objectionable iodin effects are, therefore, not uncommon. Several correspondents remark that the relative infrequency of iodism is easily explainable by the fact that syrup is rarely employed in conditions which demand an active iodin medication and that it is, therefore, always taken in small doses. In fact, the main if not the only point of superiority of the syrup appears to be in its flavor.
These clinical opinions and experiences, therefore, are in complete agreement with the judgment of the committee, namely, that the therapeutic claims made by the manufacturers for this article are exaggerated and misleading.
OTHER MISSTATEMENTS
The above is by no means the only misstatement in the printed matter issued by this manufacturer. In the publication, “The Applications of Iodin,” issued in 1907, there occur the following misleading statements which, since they refer to plainly chemical facts, did not require submission to the clinical staff:
That the administration of potassium iodid after meals greatly impairs its physiologic action “by its chemical union with the various food products” (page 19). So far as the committee knows, potassium iodid does not combine with the food products in the stomach.
“Iodid of potassium, having an alkaline reaction, neutralizes the hydrochloric acid in the gastric secretions, causing indigestion, loss of appetite and depression” (page 19). The United States Pharmacopeia states, under Potassii Iodidum: “Its aqueous solution is neutral or has a slightly alkaline reaction on litmus paper.” The slight occasional alkalinity would be physiologically insignificant, and it is absurd to claim that this alkalinity causes “indigestion, loss of appetite and depression.”
“The dose of iodid of iron is so small that the amount of iodin contained therein is of little advantage” (page 19). As a matter of fact, the pharmacopeial average dose (1 c.c.) of the Syrup of Iodid of Iron contains as much iodin (0.85 grains) as a teaspoonful of Gardner’s Syrup of Hydriodic Acid (0.83 grains).
“In hydriodic Acid the iodin is in combination with hydrogen, one of the elements of the natural secretions of the body, and is, therefore, in physiologic harmony” (page 21). No comment is needed.
It is implied elsewhere (page 29) that potassium iodid decomposes more readily, with the liberation of iodin, than does hydrogen iodid. This is contrary to the prevailing opinion, and would require definite evidence before it could be accepted. It is also stated the large doses of potassium iodid in syphilis are necessary, because the gastric decomposition prevents complete absorption. This is certainly untrue, for potassium iodid is absorbed almost quantitatively.
These, and numerous other misstatements, constitute violations of Rule 6; and it is, therefore, recommended that Gardner’s Syrup of Hydriodic Acid be removed from the list of remedies approved by the Council; it is further recommended that this report be published.
The Council postponed final action on the report, pending its submission to R. W. Gardner. This having been done, and the reply of Mr. Gardner submitted to the Council, the above report was adopted and ordered published.
W. A. Puckner, Secretary.
(From The Journal A. M. A., Nov. 14, 1908.)