IODIA
Report of the Council on Pharmacy and Chemistry
The following report on Iodia was adopted by the Council and its publication authorized.
W. A. Puckner, Secretary.
Iodia is put on the market by Battle and Company, under the claim that it contains potassium iodid in combination with iron phosphate and vegetable “principles.” It is extravagantly recommended for use in many and varied conditions. For instance, it is “an unexcelled altero-reconstructive,” “almost a specific” in eczema and rheumatism and “a highly efficient form of iodin,” which will not produce iodism!
The therapeutic effects of iodids result from a chemical transformation by which molecular iodin is set free in the tissues, thus producing a mild degree of iodism. It follows, then, that a preparation which cannot give rise to the symptoms of iodism cannot be expected to produce the therapeutic effects of the iodids. The claim that Iodia is therapeutically efficient without producing iodism therefore justifies suspicion, to put it mildly.
In view of the exaggerated tone of the advertising, together with the fact that a report from the Chemical Laboratory of the American Medical Association showed marked discrepancies between the formula and the composition of Iodia, it seemed desirable to investigate this product. The report of the laboratory, which is given below, shows conflict with Rule 1 (secrecy of composition) and with Rule 2 (false claims of standardization). A discussion of the claims made for Iodia follows the report.
LABORATORY REPORT
The composition of Iodia is given thus:
“Formula.—Iodia is a combination of active principles obtained from the green roots of Stillingia, Helonias, Saxifraga, Menispermum and aromatics. Each fluid drachm also contains two and one-half grains Iod.-Potas. and one and one-half grains Phos.-Iron.”
We are told that:
“Its several ingredients are selected with scrupulous care, and the most exacting methods are constantly employed to insure absolute uniformity and maximum therapeutic potency.”
This “formula” is an absurdity: First, the amounts of the “active principles” of the plants named are not given; second, these “principles,” with the possible exception of menispermum alkaloids, have not been isolated; and, third, ferric phosphate and potassium iodid are incompatible! Incidentally, there are no methods whereby it is possible to secure “absolute uniformity” of a mixture such as Iodia is claimed to be.
Qualitative tests demonstrated the absence of iron and the absence of all but traces of phosphorus compounds (0.015 gm. phosphorus per 100 c.c.). Minute traces of alkaloids, possibly from menispermum, were found (that amount being about 0.004 gm. per hundred c.c. of the preparation). Therapeutically this quantity is entirely negligible. Determinations of iodid demonstrated the presence of only about 60 per cent. of the amount of potassium iodid claimed. The “formula” for Iodia is false and misleading.[55]
DANGEROUS RECOMMENDATIONS
One of the Iodia labels reads:
“Indications.—Syphilitic, scrofulous and cutaneous diseases, dysmenorrhea, menorrhagia, leucorrhea, amenorrhea, impaired vitality, habitual abortion and general uterine debility.”
Such recommendations are likely to lead to self-drugging in conditions that are not only dangerous to the individual but also a menace to the community. The preparation thus conflicts with Rule 4 of the Council. After admitting the need of efficient iodid medication in certain stages of syphilis and after exaggerating the frequence and severity of symptoms of iodism, an advertising circular entitled “Practical Therapeutics” asserts:
“Iodia then is the preparation of iodid of potassium to be preferred whenever it requires to be administered in large doses or for prolonged periods of time ...
“Not only does the association of the iodid of potassium with the vegetable alteratives offer a measure of protection against iodism but the latter exert depurative effects on their own account ...”
It is generally accepted that in certain stages of syphilis the only hope of success lies in efficient iodin medication. The exploiters of Iodia state that a dose of the nostrum contains 21⁄2 grains of potassium iodid; actually it contains only 11⁄2 grains. To urge physicians and the public to depend on this product for efficient iodid medication constitutes an unwarranted therapeutic exaggeration (Rule 6) which approaches criminality. The reason Iodia does not produce iodism is that, in the doses recommended, the iodin action is extremely feeble.
Likening the human body to a factory and discussing the “break downs” which are likely to occur, a circular entitled “Always Trustworthy” says:
“When administered in proper dosage, Iodia stimulates organic functions, promotes the elimination of waste products, and re-establishes metabolic activity. It increases the solvent properties of the blood, and arrests abnormal tissue metamorphosis. In other words, it lends material assistance to weakened cells and curbs those unduly active. Iodia, obviously, has a wide range of indications. It has been most generally and successfully employed, however, in Syphilitic, Scrofulous and Cutaneous Diseases, Rheumatic and Gouty Ailments, Dysmenorrhea, Menorrhagia, Leucorrhea, Amenorrhea, Impaired Vitality, Habitual Abortion and General Uterine Debility, and wherever a reliable altero-reconstructive is required.”
These recommendations show that in addition to the objections already given, this nostrum is an unscientific shot-gun mixture. This brings it in conflict with Rule 10 (unscientific articles inimical to the medical profession and the public).
It is recommended that Iodia be refused recognition.—(From The Journal A. M. A., Nov. 21, 1914.)
BURNHAM’S SOLUBLE IODINE[P]
Report of the Council on Pharmacy and Chemistry
The Council has authorized publication of the following report on Burnham’s Soluble Iodine.
W. A. Puckner, Secretary.
Burnham’s Soluble Iodine is offered to the medical profession by the Burnham Soluble Iodine Company, Auburndale, Mass., under the claim that by
“... a new process hitherto unknown to chemistry,... Iodine is converted into a soluble article—soluble in water and soluble in gastric secretions and in the tissues.”
Beyond this no statement as to the qualitative or quantitative chemical identity of Burnham’s Soluble Iodine is furnished; this secrecy, of course, has given the preparation a certain mysterious prestige among unthinking physicians.
Burnham’s Soluble Iodine was examined in the Chemical Laboratory of the American Medical Association some six years ago and was found to be an alcoholic solution of free iodin (approximately 3 gm. per hundred c.c.) and combined iodin in the form of iodid (equivalent to about 2 gm. of potassium iodid per hundred c.c.). Thus the total iodin content was somewhat less than half of that of the official Tincture of Iodin (Tr. Iodi), which contains 7 gm. of free iodin and 5 gm. of potassium iodid to each 100 c.c. The official tincture, diluted one-half, therefore, would be essentially equivalent to the Burnham preparation, both being miscible with water. The Burnham Soluble Iodine Company objected to the conclusions drawn, from this analysis, but admitted the correctness of the analysis itself.
Any one who gathered his first knowledge of the subject from the Burnham advertising might readily infer that no soluble iodin had been known prior to Burnham’s Soluble Iodine. This, of course, is not the case; the method of producing a solution of iodin by the use of an iodid has long been known.
The following statement is not only obviously untrue but also nonsensical:
“In all the history of iodin medication, covering a period of laboratory research of many years duration, every effort to produce a free iodin, prior to the evolution of Burnham’s Soluble Iodine, was attended by failure.”
The company lays stress on the assumed superiority over the iodids of a preparation containing free iodin. This assumption is based on a fallacy. Those who regard free iodin as superior to combined iodin forget that free iodin taken by the mouth is converted in the intestines, by the action of the alkaline intestinal secretions, into an iodid with a small amount of iodate, while administered intravenously (a procedure that, while advocated by the Burnham concern, is therapeutically indefensible), it enters into combination with the alkaline salts and proteins of the blood. The free iodin in Burnham’s Soluble Iodine must act in the system as an iodid, and the whole iodin content, to furnish a correct estimate of the value of the preparation, should be reckoned as an iodid.
Bearing this in mind, then, it is evident that the doses of Burnham’s Soluble Iodine recommended by the manufacturers are extremely small. They range from 20 minims (equivalent to 1 grain of potassium iodid) to 1⁄2 minim (equivalent to 1⁄40 grain of potassium iodid). From 5 to 20 minims (equivalent to about 1⁄4 to 1 grain of potassium iodid) is the dosage recommended for syphilis; from “1 to 3 minims [equivalent to from 1⁄20 to 3⁄20 grain of potassium iodid] three to six times daily” for typhoid and other intestinal diseases. No wonder the exploiters can say that this nostrum does not irritate the intestines, that it is “non-irritating to the weakest stomach” and that there is an “entire absence of toxic action from maximum doses”! Its alleged freedom from the irritating and untoward effects of ordinary iodids is due, not to any inherent superiority of the preparation, but to the insignificant amount of iodid present.
The preparation is advertised for use in an extremely wide range of diseases, in some of which iodid therapy is recognized as of value, while in others it is generally regarded as either worthless or harmful. Given orally or intravenously (the recklessness of the latter method should again be emphasized) Burnham’s Soluble Iodine is claimed to be of:
“... great utility as an internal antiseptic in tubercular affections ...”
Since, as previously explained, free iodin, when introduced into the body, enters into chemical combination before it has a chance to permeate the tissues, and since the alkali iodids possess very slight (in fact, for this purpose, negligible) antiseptic powers, it is evident that this claim is unfounded. So, for the same reason, is the claim that “as an intestinal antiseptic,” Burnham’s Soluble Iodine is:
“... efficient in Typhoid Fever, Enteritis and other intestinal diseases.”
It is recommended in exophthalmic goiter, notwithstanding that this condition is generally recognized as contraindicating the administration of iodids, which excite the action of the thyroid gland, and which therefore must be used with great circumspection. An especially indefensible recommendation is that 1⁄2 minim of Burnham’s Soluble Iodine (equivalent to 1⁄40 grain of potassium iodid) be administered every five minutes in “membranous croup”—diphtheria—until relief from dyspnea is obtained. But, of all the extravagant claims made for this preparation, perhaps the following is the most reprehensible:
“In the treatment of Phthisis, in its various forms, clinical evidence clearly indicates that the use of SOLUBLE IODINE affords the most potent method of treatment available. Dose—2 minims, increasing to 5 minims in four ounces water before meals.”
Remove the mystery and tell physicians that a dose of 1⁄10 or 1⁄4 of a grain of potassium iodid is “the most potent method of treatment available” in tuberculosis and the absurdity becomes self-evident. Nor is this the worst feature of the advice here offered. Iodin, by combining with the fatty acids of tuberculous tissues, promotes their autolysis and consequently their softening and breaking down. The products of this autolysis are carried by the lymphatics to healthy tissues and thus may spread the infection. Therefore the use of iodids in tuberculosis, even in small dosage, should not be undertaken lightly.
It is recommended that Burnham’s Soluble Iodine, a semi-secret preparation, exploited by means of extravagant and dangerous therapeutic claims, be held ineligible for admission to New and Nonofficial Remedies, and that this report be published.—(From The Journal A. M. A., May 15, 1915.)
IODOTONE[Q]
Abstract of Report of the Council on Pharmacy and Chemistry
Eimer and Amend, New York, who market Iodotone, state that it is a solution of hydrogen iodid (hydriodic acid) in glycerin, containing 1 grain of iodin to each fluid dram. The unwarranted assertion is made that Iodotone
“... will produce the constitutional effect of iodine in a shorter time than other preparations ...”
This cannot be true, for it is certain that, because of the alkaline reactions of the tissues, iodids, whether administered as hydrogen iodid or as alkali iodids, must circulate in precisely the same form and therefore exert the same therapeutic effects in precisely the same way.
Eimer and Amend further assert that the ordinary iodids may to advantage be replaced by Iodotone. The absurdity of this claim is apparent when it is considered that it will be necessary to administer nearly one fluidounce of glycerin to obtain an amount of Iodotone equivalent to a 10-grain dose of potassium iodid. The additional claim that Iodotone will not disturb the stomach or produce the usual disagreeable symptoms of iodism is evidently unwarranted, for it is generally conceded that symptoms of iodism can be avoided only at the risk of insufficient iodin medication. Because of these unwarranted and misleading claims and because the name Iodotone would tend toward the uncritical use of the preparation as a general tonic, the Council voted that Iodotone be refused recognition.—(From The Journal A. M. A., Dec. 12, 1914.)