PAM-ALA, ANOTHER WORTHLESS QUININ SUBSTITUTE

Report of the Council on Pharmacy and Chemistry

The following report of a referee on Pam-ala, an asserted malaria specific, was adopted by the Council and its publication authorized.

W. A. Puckner, Secretary.

Soon after publication of the Council’s report on Sinkina, an alleged malaria specific proved worthless, the referee’s attention was called to Pam-ala, which is sold under very similar claims.

According to the advertisements which have been appearing in Southern medical journals, Pam-ala is “A new and effective remedy for MALARIA.”

The label describes Pam-ala as “An Effective Vegetable Remedy For MALARIA. Guaranteed free of any Quinine, or other harmful [sic] drugs.” It is said to be indicated in “Malarial Intermittent and Remittent Fevers, especially curative in Chronic Malaria and Malarial Cachexia and all conditions even where Quinine fails.” One tablespoonful three times a day is said to be the “Curative Dose,” while one tablespoonful three times a week is stated to be a “Prophylactic Dose.” The label further claims that Pam-ala “Surpasses Quinine in its action and has none of its Disadvantages.” Assertions that Pam-ala is superior to quinin are followed by the usual “guarantee” claim: “Guaranteed by the Pam-Ala Co. under the Drugs Act, June, 1906, Ser. No. 2909 A.” Finally, the label says that it is “Endorsed by Medical Authorities Throughout the world.”

As regards the composition, a circular says that “PAM-ALA is a purely vegetable remedy for the cure, without Quinine, of all forms of Malaria.” “‘Pam-ala’ is derived from a plant of the genus Umbelliferae, a native of the mountainous regions of Mexico and northern parts of South America. Its medicinal properties have not been known to anyone but the native Indians, who for years past have used it as a specific in all forms of fever and malarial diseases so prevalent in tropical countries. The seeds are more active as a therapeutic agent than the dried-up plant; hence their collection for medicinal purposes requires special skill in the selection of the same so as to be able to extract all the possible medicinal properties from them, viz., its active principle. An oil may be abstracted from the seeds which is of a yellow color with an intense characteristic odor.”

At the close of the circular the following unenlightening formula appears:

Each fluid ounce contains:
Ext. Fid. Pam-ala	10 per cent.
Alcohol	15 per cent.
Ol. Aurant Syr. Sacchari aqua ad. q. s.	100 per cent.

In addition to being a cure for malaria, Pam-ala is claimed to have a “favorable influence upon the broncho-pneumonia of measles ...,” “will avert an attack of acute catarrh,” and “abort acute tonsilitis.”

The testimonials are of the usual character. Most of them seem to have been given some four years ago by physicians in Italy, Cuba, Porto Rico, Guatemala, etc., and therefore cannot readily be looked into. Two are of more recent date and come from physicians in this country. They furnish good illustrations of the manner in which proprietary concerns make use of opinions hastily formed and thoughtlessly put in writing. One testimonial was given in July, 1912:

“I take pleasure in testifying to the seemingly marvelous and gratifying effect of Pam-ala in 2 cases of malaria....”

On Jan. 2, 1914, its writer, in reply to an inquiry whether in the light of continued experience, his first estimate of Pam-ala had been confirmed, wrote:

“... Since then I tried Pam-ala on a number of cases without any results whatever; in fact my patients seemed to get worse until I resorted to the usual treatment of malaria, mercurial laxative followed with quinin. I was too hasty in stating that Pam-ala cured malaria. I now know and have known since August, 1912, that Pam-ala will not cure malaria....”

The writer of the second testimonial is reported to have written that he tried Pam-ala “on a most pronounced case of malarial spleen with the most excellent results” and that he “also tried Pam-ala on a case of Malarial Cystitis and Hematuria, with entire satisfaction.” In reply to inquiry this physician admits that he was “very favorably impressed with the preparation at the time.” He states that at that time he was also trying out Sinkina and that after six months he “discontinued the use of both as the results did not warrant further investigation.” He concludes:

“With due allowance for the fact that certain cases will for a time improve on any kind of treatment, new or old, I see no reason for supplanting or even augmenting, the recognized treatment for malarial conditions, with either Pam-ala or Sinkina.”

Incidentally it should be mentioned that this physician also noted the general similarity of Sinkina and Pam-ala. He observes:

“The physical appearance and properties of the two preparations seem to be identical, the advertising matter and literature are surprisingly alike and the only marked difference seems to be that one remedy is purported to be prepared from a ‘new’ South American plant and the other from an equally fresh discovered addition to Asiatic flora.”

WHAT IS PAM-ALA?

From a comparison of the statements regarding the composition which are made for Sinkina and for Pam-ala, as well as from the physical characteristics of the preparation, particularly the odor and taste, it seems evident that the essential constituent is oil of cumin. Although definite proof that oil of cumin forms the essential constituent of Pam-ala would have shown the worthlessness of this nostrum for the reason that the clinical investigation of Sinkina proved the worthlessness of oil of cumin, it did not seem worth while to the referee that this be demonstrated by chemical analysis. It seemed to him that in such cases as these, the secrecy with which the identity of the preparation is surrounded, as well as the extravagant and highly improbable claims, should be sufficient to condemn it.—(From The Journal A. M. A., Feb. 28, 1914.)

PAPAYANS BELL [X]

Report of the Council on Pharmacy and Chemistry

The following report of a subcommittee was submitted to, and adopted by, the Council and its publication directed.

W. A. Puckner, Secretary.

Papayans (Bell) made by Bell & Co., Orangeburg, N. Y., is said to consist of the “digestive principle obtained by our own exclusive process from the fruit of Carica papaya, combined with willow charcoal, chemically pure sodium bicarbonate and aromatics.” The following statement appears on the package: “For the treatment of dyspepsia, flatulence, nausea, vertigo, hyperacidity, palpitation and other symptoms of indigestion and the vomiting of pregnancy. Peritonitis, cholera morbus, alcoholism and seasickness.” “Digests every variety of food, removes every symptom of indigestion, restores the entire digestive tract to a normal condition.” The dosage is recommended as follows: “From one to three tablets before meals, or two hours after eating. In severe cases, three tablets dissolved in hot water and repeated as necessary.”

A circular which accompanies the package details the therapeutic virtues of the preparation and contains what purports to be extracts from medical journals, in which Papayans is recommended.

Examination of specimens purchased in the open market showed them to contain the following ingredients: Charcoal, sodium bicarbonate, ginger, saccharin and oil of gaultheria. As the product is said to contain papain, the presence of enzymes was tested for, with the result that it was found to possess neither proteolytic nor amylolytic properties. The results of our examination are in accord with the results obtained by a member of the Council, who examined the product independently, and who writes:

“We have made some extended tests with Papayans Bell, and find that the tablets consist essentially of sodium bicarbonate and charcoal, with a little flavoring matter. We find no digesting power for starch or egg albumin. At any rate, no appreciable change follows in the albumin in three hours, and no conversion to sugar in the same time, or change of starch to a point where the iodin reaction is weakened. The product seems to be practically inert.”

It is recommended that Papayans Bell be refused recognition, and that publication of this report be authorized.

Comment: It will be remembered that two other products of Messrs. Bell & Company have been discussed in this department: Salacetin (Bell)[61] and Sal-Codeia (Bell).[62] Salacetin was examined with several “synthetics” which all turned out to be mere acetanilid mixtures. Salacetin, advertised as “a combination, with heat, of Salicylic and Glacial Acetic Acids and Phenylamine” when examined “was found to be a mixture and to contain the following ingredients approximately in the proportion given: Acetanilid 43; sodium bicarbonate, 21; and ammonium carbonate, 20.” Sal-Codeia (Salacetin-Codein) therefore, would be the same with codein added.

Papayans (Bell) seems to be consistently fulfilling the life-history of the average nostrum. Made of well-known drugs and invested by its manufacturers—or exploiters—with virtues absurdly disproportionate to the known properties of the alleged constituents of the nostrum, the preparation was introduced to the world via the medical profession. With the help of thoughtless physicians, aided by a skilful and aggressive advertising campaign and augmented by the “free sample” device, the business grew and prospered. The bottles with the name and address of the company blown in the glass and with the varied therapeutic indications for the nostrum printed both on the label and on the circular in which the bottle is wrapped, have carried the manufacturer’s message to the drug-taking public.

Apropos of this point, the recent “literature” contains what purports to be endorsements of the nostrum by medical journals. Thus there is quoted from the New York Medical Journal, Jan. 2, 1909, in part, the following recommendation: “... we venture to suggest to our readers who have not tried this remedy that they prescribe one original sealed package of Papayans (Bell) and that they carefully note the results from its use.” [Italics ours.—Ed.] Having seen an “original sealed package” we believe that we can predict the “results from its use.” On any patient not mentally unbalanced, the result would be that the next dose of Papayans (Bell) he thought that he needed would be purchased from the druggist direct.

That such results are not hypothetical is evidenced by the statements of the exploiters of Papayans (Bell) that “the annual sale now exceeds four hundred million tablets.” Assuming that statement to be true, it would be necessary for every physician in the United States to prescribe over three thousand of these tablets every year—if they reached patients only through the physician! The company’s own figures indicate that the time is about ripe to take care of this vast army of self-drugging laymen and recent circular letters seem to recognize it. The physician is notified that druggists are now furnished with Papayans (Bell) “in sealed packages of thirty and one hundred tablets.” The medical man is told that the firm has “not forgotten the days when physicians’ orders made our success possible” and it says it is “sincerely grateful to the doctors who gave us orders in the days when we were struggling for recognition.” This tacit admission of the value of the physician as an unpaid agent for nostrum houses should be given thought by those physicians who prescribe such preparations.

While, so far as we know, Bell & Co. have not yet advertised in the daily press, they are not averse to furnishing the laity with samples when requested. An Ohio physician sent us the following letter received by a young woman who had written asking for samples:

Miss X—— Y——,
Z——.

Dear Madam: As requested, we are mailing you sample of our Papayans (Bell) for Indigestion.

If a sufferer from Indigestion, we want you to give it a thorough trial as directed and note remarkable results that we believe you will get from its use.

Kindly write us if you are unable to obtain it from your local druggist, as it is stocked by nearly every good drugstore in the United States.
Yours truly,

Bell & Co.

Evidently Bell & Co., while admitting that their financial success is largely due to the kindly, though misguided, efforts of physicians, are not going to let a little thing like loyalty to the medical profession interfere with a possible sale of their tablets.

THE L. D. JOHNS COMPANY

A discussion of the methods of Bell & Company would not be complete without reference to a concern which seems to be closely connected with it: the L. D. Johns Company, whose “only product” is a sugar-coated laxative tablet. Regarding the “sugar coated” tablet, a visitor at the place of business of Bell & Company and the L. D. Johns Company wrote: “These companies apparently are not in possession of any tablet coating machines and in questioning on this point stated that some of their tablets were sent out to be coated.” There is a sameness regarding the claims for the laxative tablets of the two companies that might lead one to suspect that the same individual prepared both circulars. For instance:

Cascarans (Bell)		Dr. Johns’ Tablets
“Taken as directed, it permanently removes the great majority of cases of habitual constipation.” “... a harmless vegetable preparation.” “... for the removal of pimples, yellowness and greasiness of the skin ...” “... one tablet at night, one night and morning, or, in severe cases, one three time a day, gradually decreasing the frequency of the dose as improvement permits.”		“Taken as directed ... permanently remove the great majority of cases of habitual constipation, torpid liver and sick headache.” “A harmless vegetable remedy.” “... removes pimples, blotches, sallowness and greasiness of the skin ...” “One at night, one night and morning, or, in severe cases, one three times a day. Gradually decrease the frequency of the dose as improvement permits.”

According to a leaflet sent out with samples by the L. D. Johns Company, the company is capitalized for $500,000, divided into 50,000 shares at $10 each; these shares are sold to those physicians who will agree “to prescribe the tablets at every suitable opportunity, to introduce them to other physicians” and “to promote their sale in every ethical way!” If the list of physicians’ names and addresses which the company sends out as comprising the eastern stockholders is to be relied on, it would seem that many medical men are promoting their sale. In prescribing it is, of course, “necessary to specify ‘Dr. Johns’ Tablets No XXX (Original bottle).’” As the name is on the bottle, it is not unbelievable that, as the company says in its prospectus, because of “our method of advertising, a large and very profitable business is being created.” That the L. D. Johns Company expects to profit by the self-drugging which this method of prescribing fosters is evident:

“Physicians not stockholders in this company suffer from the continual refilling of their prescriptions and from the recommendation of the preparation prescribed by patients to others. [Italics ours.—Ed.] Our stockholders benefit by the refilling of their prescriptions and by these recommendations.”

Put baldly the case amounts to this: Physicians who prescribe “Dr. Johns’ Tablets” not only are likely to foster self-drugging, but they will reap dividends therefrom. Truly a nice business to be in!

While Bell & Company and the L. D. Johns Company are said to be entirely distinct, they are to be found at the same address at Orangeburg, New York, and as will be seen, the officers of the two companies are more or less related.

BELL & CO.		L. D. JOHNS CO.
President	John L. Dodge	President
Secretary	Geo. C. Tennant	Vice-President
Vice-President	Chas. B. Smith	Secretary and Treasurer

EXPLOITING THE PROFESSION

Nostrum promoters have two simple ways of “working” the medical profession. The first—and the more profitable—is, by lavish distribution of free samples, to get physicians to prescribe the blown-in-the-glass “original package” with the inevitable result of large sales direct to the laity. By the second method, which is merely a modification of the first, the physician furnishes the capital for floating the nostrum and then takes his share of the resulting profits. There may not be quite as much money in the second method for the promoter, but then the risks are correspondingly less. If the firm fails, the stockholders are the losers; the promoter is not necessarily “out” anything. From a commercial standpoint, a combination of the two methods is, of course, ideal—(From The Journal A. M. A., Aug. 14, 1909.)

PASSIFLORA AND DANIEL’S CONCENTRATED TINCTURE OF PASSIFLORA [Y]

Report of the Council on Pharmacy and Chemistry

The Council has voted that the drug passiflora (passion flower) be not accepted for New and Nonofficial Remedies, and has recommended that the following article be published in The Journal. It is considered important to call attention, not only to the lack of reliable evidence of the therapeutic value of passiflora, but also to the absurdity of the claims which are made for Daniel’s Concentrated Tincture of Passiflora, a preparation which has been already refused recognition.

W. A. Puckner, Secretary.

Passiflora

Although passiflora was introduced into medicine nearly seventy years ago, the literature concerning it is not very extensive; it is not mentioned in the standard works on pharmacology and its chemistry seems never to have been worked out. There appears, also, to be no record of experimental investigations of the drug with reference to its pharmacologic action, except an article by I. Ott,[63] who used “Daniel’s Concentrated Tincture.” Ott claimed that it lessened the reflex irritability of the cord and paralyzed motion by acting on the motor centers in the cord, and that it increased the rate of respiration. He also stated that because of its action on the vasomotor centers it reduced the frequency of the heart-beat and lowered arterial tension, but that these effects were only temporary.

On the clinical side the reports are not numerous and such as have been made do not appear to be based on very extensive trials nor on conditions of observation that would entitle them to more than slight consideration. S. D. Bullington [64] reports good results, but no cure, in one case of epilepsy, and improvement in a case of insomnia. W. J. Stapleton [65] recommends it in the form of a concentrated tincture (not the one advertised so extensively), and states that he has used it with great success in insomnia, hysteria, neurasthenia, neuralgia, nervous and physical prostration, and in alcoholism. In his opinion its action is most apparent in cases of nervousness due to causes other than pain. S. Harnsberger [66] reports two cases in which partial blindness followed the taking of potassium bromid and passion flower.

Extravagant and inconsistent claims are made for Daniel’s concentrated tincture of passiflora in the advertising literature, where it is recommended for such a wide range of diseases as asthma, typhoid fever, convulsions and paralysis.

None of the evidence is sufficient to show that passiflora has therapeutic value; hence it is deemed inadvisable to include this drug in the list of nonofficial remedies.—(From The Journal A. M. A., March 19, 1910.)

LIQUID COMBINATIONS CONTAINING PEPSIN AND PANCREATIN [Z]

Report of the Council on Pharmacy and Chemistry of the American Medical Association

The following report was submitted to the Council by a subcommittee:

To the Council on Pharmacy and Chemistry:—The U. S. Pharmacopeia, 8th revision, pages 334–5, states: “Pepsin and pancreatin in solution are incompatible with one another. If the solution be neutral or alkaline the pancreatin gradually destroys the pepsin, and if acid the pepsin destroys the pancreatin.” The correctness of this statement has been amply demonstrated by the reports which have been submitted to the Council from time to time on liquid preparations claimed to contain these two ferments.

Thus an elixir was investigated which was by the manufacturers claimed to contain “the five active agents of digestion, pepsin, veg. ptyalin, pancreatin, lactic and hydrochloric acids,” and to be “superior to all other remedies in dyspepsia and diseases arising from imperfect digestion,” and the committee which investigated the article in question reported that “it was impossible to establish the presence of either the proteolytic or the amylolytic ferment.”

Similarly, on another liquid preparation, which was said to contain “pancreatin, pepsin, lactic and muriatic acids, etc.” ... “the combined principles of digestion to aid in digesting animal and vegetable cooked food, fatty and amylaceous substances,” the committee reported “this product possessed only very slight proteolytic action and failed to digest 2 per cent. of its own weight of starch.”

Again, the report on still another preparation stated: “But while it was said to contain pancreatin, the U. S. P. test for the valuation of pancreatin failed to indicate this ferment.”

The report on yet another elixir, claimed to be “the only true digestant, because it contains the enzymes of all the glands which are necessary for digestion,” showed that this article did not contain “any appreciable enzyme activity, either amylolytic or proteolytic.”

The correctness of these findings of the committee of the Council was generally acknowledged by the manufacturers when their attention was called to the matter. Thus, one manufacturer of digestive ferments writes: “We will ask you to hold this matter up until you hear from us further on the subject. The reason for this request is that we have been going over our liquid preparations very carefully in order to be sure that after aging they would contain the ferments that we put into them. The pancreatic ferments in alcoholic liquids seem to lose their strength.”

The chemist for a large manufacturing house writes: “There are now on the market a number of preparations in which pepsin and pancreatin are combined in liquid form, and the result is that we have had numberless requisitions from our representatives that we also market such a preparation. As the result of this we have carried out a series of experiments no less than four or five times in order to determine whether pepsin, diastase, and pancreatin would retain their activity in the form of a syrup, wine or elixir. We have proved incontrovertibly that this cannot be done. While any two of these substances, or even all three of them, can be dispensed in the form of a liquid by the retail druggist and will retain their normal activity for as long a period as three to six weeks, yet if allowed to stand sufficiently long, they mutually destroy each other; so that in a combination of pancreatin and pepsin the pancreatic enzyme is lost and the pepsin greatly injured, and where diastase is present, both diastase and pepsin (or diastase and pancreatin) mutually destroy each other.”

Since it has been demonstrated that pepsin and pancreatin cannot exist in one and the same solution for any reasonable length of time, it becomes apparent that liquid preparations said to contain these two ferments are sold under impossible claims. It is therefore recommended:

1. That the Council on Pharmacy and Chemistry refuse to approve liquid preparations that are claimed to contain both pepsin and pancreatin.

2. That the medical profession through the Journal of the American Medical Association be advised of the fallacy of employing such combinations.

3. That the attention of manufacturers be called to the worthlessness of such incompatible liquid preparations of pepsin and pancreatin, and that they be urged to cease offering such products to the profession.

4. That, since the National Formulary has recognized a preparation of this kind under the title “Elixir Digestivum Compositum,” the American Pharmaceutical Association be requested to instruct its committee on the National Formulary to omit this preparation from the next edition.

The recommendations of the subcommittee were adopted by the Council and publication of the report directed.—(From The Journal A. M. A., Feb. 2, 1907.)

W. A. Puckner, Secretary.