PHENOLPHTHALEIN
Phenolphthalein has long been used as an indicator in chemical reactions, but its use as a therapeutic agent[115] is comparatively new. When its laxative properties were first discovered it was exploited as a proprietary in Germany, and it was not long before the enterprising manufacturers in this country saw in it a potential gold mine and now nearly every proprietary drug manufacturer in this country has coined a proprietary name for it and is exploiting it, either alone or in combination with one or more other laxatives, and with more or less unwarranted claims.
Phenolphthalein itself has certain pretty well defined properties, but when a little of some other drug has been added wonderful therapeutic possibilities are claimed for the combination. The drug also has a definite market value and the pure substance in the form of powder, tablets or pills could not be sold at a price greatly in excess of the market value. Thus manufacturers, from business policy, add to it other drugs. There are now on the market numerous more or less secret and “fancy” preparations of phenolphthalein for which a price is charged out of all proportion to the value of the preparation. Among these are:
Phenolphthalein Laxative (El Zernac Co.).
Exurgine (Bischoff & Co.).
Probilin (Schering & Glatz).
Prunoids (Sultan Drug Co.).
Laxine (Columbus Pharmacal Co.).
Phenolax Wafers (Upjohn Co.).
Laxaphen (Parke, Davis & Co.).
Phenalein (Pax Chemical Co.).
Thalosen (Abbott Alkaloidal Co.).
Laxothalen Tablets (Pitman-Myers Co.).
Veracolate (Marcy Co.).
And additional preparations are still coming out! Some of the preparations contain only the phenolphthalein with a coined non-descriptive proprietary name attached, but most of them contain in addition one or more of such drugs as cascara, sulphur, prune, senna, salicylic acid, ipecac and aromatics. The exploitation of phenolphthalein in this way gives opportunity to the manufacturers to make all sorts of strong claims, some of them directly contradictory, for their preparations. For instance, Phenolax, which is said to contain phenolphthalein and cane sugar, is claimed to be “a great success for all forms of constipation, intestinal atony and hepatic torpor.” Of Laxothalen, which is said to contain phenolphthalein, aromatics and sugar, it is stated that “its action is confined to the bowel and it has practically no hepatic action.” Of Prunoids, which is said to contain phenolphthalein, cascara, de-emetized ipecac and prunes, we have the old familiar statement that “the harmonious blending of the several ingredients will give results that cannot be obtained through their use separately, nor will their use be followed by after-constipation.”
At the time phenolphthalein was beginning to be exploited in this country The Journal[116] suggested that physicians who wished to try the remedy should prescribe it under its own name and not under fancy, coined names. Since phenolphthalein occurs in the form of an insoluble and tasteless powder there is no reason why special pharmaceutical preparations of it should be placed on the market. It can be prescribed in powder form, in pills, capsules or tablets. Thus given, the true therapeutic action of the drug would be apparent and its actual value arrived at.
The vice of this unscientific habit of prescribing names instead of drugs is stated in a forcible way in a letter received from Dr. V. E. Simpson, a teacher of materia medica and therapeutics in the medical department of the University of Louisville. He says:
“Recently P. D. & Co.’s representative left on my desk a sample labeled ‘Laxaphen.’ The formula given is: phenolphthalein, gr. viii; salicylic acid, gr. 3⁄5, in each fluidounce, ‘incorporated in a palatable chocolate base.’ Now, in the first place, this name is one that the public will easily learn and will soon call for; in the second place, it is not a name that carries with it even a suggestion of its contents; and, finally, the physician acquires the habit of mechanically prescribing names instead of drugs, and in the burdening of his memory with the myriad of fantastic labelings he finds it impossible to remember even the drugs any one contains, much less the exact proportions of those drugs. Then suppose that a consultation is had; the consultant asks what is being given and the attendant answers that he is giving ‘laxaphen.’ The consultant, perhaps, has not been sampled and inquires about it; the attendant must answer. ‘Oh, it contains some phenolphthalein and a salicylate, but I have forgotten the exact proportions. I have the literature on my desk.’ Had he used U. S. P. and N. F. remedies, which the consultant and every other doctor in the land has access to and should have some knowledge of, this embarrassment would not occur.”
All of the above should remind the physician that he should write simple prescriptions, for drugs whose action he knows, adapted to the particular case and not for money-making combinations under fanciful, non-descriptive names exploited by the proprietary manufacturers. In this way he will not only save money for himself and his patients, but he will be giving them exact and effective treatment, he will know exactly what he is giving and learn for himself its effect, and he will be following the only method which entitles him to be called a scientific physician.—(From The Journal A. M. A., April 30, 1910.)
MIXED VACCINE AND PHYLACOGENS[AO]
The noted advance in therapeutics shown in the development of vaccine therapy has brought with it grave dangers as well as advantages. We have, on a number of occasions, discussed in special articles and in editorials the dangers which threatened from the rapid commercialization of this new method. The unscientific character of mixed vaccines and of the mixed filtered products of a number of vaccines marketed as “Phylacogens” has been especially emphasized and the danger from their indiscriminate use pointed out. A little over a year ago we published a series of articles dealing with the whole subject in which the nature of mixed vaccines was described[117] as follows:
“The mixed stock vaccine of commerce is a makeshift. It is offered as a substitute for correct diagnosis. Like all such makeshifts in science, it is doomed to failure.... A burden is being forced on the profession which will speedily assume the proportions attained by proprietary drug combinations. The menace cannot be counteracted unless physicians will accept the guidance of unselfish, non-commercial interests and refuse to purchase and use mixed commercial vaccines.”
This admonition to seek the guidance of unbiased scientific observers is deserving of special emphasis at the present time. Five weeks ago we published the address of the chairman of the Section on Pharmacology and Therapeutics, Dr. John F. Anderson,[118] one of our foremost workers in this branch of biologic science, in which attention was very forcibly drawn to the dangers involved in the use of biologic products of non-specific character. He says:
“Bacterial therapy undoubtedly in some cases is a most valuable method of treatment; but when the claim is made that a combination of the dead bodies or the filtered products of a number of different bacteria are useful for the treatment of certain diseases with a different specific cause, it would seem that the suggestion closely approaches quackery.”
Further he says:
“Aside from the doubtful practice of the indiscriminate use of unproved methods of treatment, it has seemed to me that a great injustice is done the patient by their use, since some of the preparations that have been widely exploited have been shown to be harmful in certain instances and even to have caused death. So the first step in attempting to remedy conditions is to awaken the physician to the importance of ignoring the claims of those who are pushing these new methods until their usefulness and harmlessness has been clearly demonstrated by those best in a position to do so.”
As a result of scientific methods in teaching therapeutics, physicians have gradually given up almost entirely the use of “shotgun” prescriptions and now prescribe a drug or a combination of a few drugs, each given for the purpose of exerting a definite action. On the other hand, the purveyors of bacterial vaccines have gradually increased the number of different bacteria in their mixed vaccines until some of those now advertised for sale contain as many as seven different kinds of bacteria, and some of the “Phylacogens” contain the filtered products of at least eleven bacterial species!
Under the present federal laws there does not seem to be any way in which the federal government can do more than is being done at present. It is a case in which the physician becomes the sole guardian of the patient committed to his care. He is the one and the only responsible individual. He cannot throw the blame for bad results back to the manufacturer. When he subjects his patient to the possibility of harm by the use of these unscientific and dangerous preparations, the physician assumes the responsibility, whether he wants to or not.
If physicians would report their failures when these vaccines are used, and especially report the fatalities consequent on their use, with the name of the manufacturer of the particular product used, we are quite sure there would result lessening in the enthusiasm of the purveyors of these products.
When tempted by the optimistic statements of the interested manufacturer of these mixtures to give them a trial the physician should remember that the warnings of disinterested scientists are of far more value than uncritical clinical reports put out under commercial auspices.
This we quote from a recent book by Victor C. Vaughan,[119] President of the American Medical Association:
“Every time an unbroken protein is introduced into the body it carries with it, and as a part of it, a poison. From the very careless, rash, and unwarranted way in which ‘vaccines’ of most diverse origin and composition are now used in the treatment of disease, this matter certainly cannot be understood or its danger appreciated by those who subject their patients to such risk. It should be clearly understood that all proteins contain a poisonous group—a substance which in a dose of 0.5 mg. injected intravenously kills a guinea-pig. This poison is present in all the so-called ‘vaccines’ now so largely used, and it is not strange that death occasionally follows the use of ‘Phylacogen’ or similar preparations. Not only do these proteins contain a poison, but when introduced parenterally the poison is set free, not in the stomach, from which it may be removed, but in the blood and tissues. It is possible that vaccine therapy may become of great service in the treatment of disease. Even now there are occasional brilliant results which are reported while the failures and disasters are not so widely advertised.”
Such a warning as this quotation contains, from a man so eminent as Dr. Vaughan, merits and should receive the careful attention of medical men; at least it should have as much weight as the “clinical evidence” spread broadcast among our profession by commercial houses.—(From The Journal A. M. A., Aug. 29, 1914.)