The Propaganda for Reform in Proprietary Medicines, Vol. 1 of 2

by Council on Pharmacy and Chemistry

SAL HEPATICA

Report of the Council on Pharmacy and Chemistry

Sal Hepatica, marketed by the Bristol-Myers Co. of New York, has been refused recognition by the Council, because its composition is secret; because it is advertised indirectly to the public for the treatment of diseases; because exaggerated and unwarranted claims are made for its therapeutic qualities; and because the name fails to indicate its chief constituents but does suggest its use in liver disorders.

The Council has authorized the publication of the report of its referee, because it is an important illustration of the ways in which physicians are being made parties to the introduction to the public of a patent medicine, whose indiscriminate use must often have resulted in harm, direct or indirect.

W. A. Puckner, Secretary.

The report of the referee follows:

Sal Hepatica is a saline laxative sold by the Bristol-Myers Company of New York. No information seems to be given regarding its composition except such as is contained in the following vague and uninforming phrases:

“Effervescent saline combination, hepatic stimulant, laxative and an eliminant of irritating toxins.”

“Sal Hepatica is a saline combination containing the alterative and laxative properties similar to the natural ‘Bitter Waters’ of Europe with the addition of sodium phosphate.”

“... more palatable and efficient than sodium phosphate alone or other salines.”

A circular around the bottle contains the following:

“We invite the physicians’ careful consideration of the merits of Sal Hepatica in the treatment of Rheumatism and Gout, in Constipation and Auto-intoxication, and to its highly important property of cleansing the entire alimentary tract, thereby eliminating and preventing the absorption of irritating toxins and relieving the conditions arising from indiscretion in eating and drinking.”

In the same circular, its promiscuous use is invited in these terms:

“Owing to its palatability, Sal Hepatica is particularly well adapted to the requirements of childhood or the feeble and delicate.”

Further suggesting its use in the treatment of that popular, if somewhat vague ailment, “biliousness,” we read:

“It is especially valuable where there is intestinal sluggishness arising from functional derangements of the liver or portal circulation....”

As further suggestive of its all-around “goodness,” are the claims:

“It increases the appetite and promotes digestion by stimulating the flow of gastric juice.”

“In rheumatism and gout Sal Hepatica furnishes the physician with an ideal eliminant, usually affording prompt relief.”

The label on the Sal Hepatica bottle suggests—both to physicians and to the public—​its use in the following diseases and conditions:

“Derangements of the stomach and liver.”
“Affections of the kidneys.”
“Bilious attacks.”
“‘Summer complaints,’ colic and alcoholic excesses.”
“Headache, dizziness, heartburn and seasickness.”
“Acute indigestion.”
“Gastric, hepatic and renal disorders.”
“Especially beneficial in rheumatism and gout.”

From these quotations it is evident that Sal Hepatica is in conflict with:

Rule 1, in that its composition is not disclosed, although statements are made which are likely to give a false impression as to what it is;

Rule 4, in that the statements on the label and in the circular around the bottle advertise it to the public and thus make the physician who recommends it an advance agent for the nostrum;

Rule 6, in that exaggerated and unwarranted claims are made for its therapeutic qualities, and,

Rule 8, in that its name fails to indicate its chief constituents, but does suggest its use in liver disorders.

The absurd claims made for this preparation are such as to put it in the “patent medicine” class. Even the most credulous members of the medical profession certainly can take no stock in the claim that a preparation can be an “eliminant” of uric acid, a hepatic stimulant, a remedy for gout, rheumatism, liver disease, indigestion, etc. Why then should such a preparation be tolerated?

In its conflict with Rule 4 Sal Hepatica belongs to that class of nostrums which have been so successfully exploited by manufacturers through the unwitting efforts of thoughtless and careless physicians. The Bristol-Myers Company has been most liberal in distributing free samples, evidently with the assurance that physicians would do the rest. Thus, at the present time, the profession is being supplied with a package containing one regular 25-cent bottle and five single-dose vials bearing the name Sal Hepatica. If only a small percentage of the physicians who receive these samples distribute them, the increase in Sal Hepatica consumers may be imagined. How successful this scheme of the Bristol-Myers Company has been is only too evident. Sal Hepatica is one of the best-selling laxatives in department stores and drug stores to-day.

While the evils of indiscriminate purgation are now generally recognized, the referee wishes to quote and to indorse the pertinent comments on this subject by The Journal:[79]

“The abuse of saline cathartics by the public is an evil deserving of serious attention. Rightly or wrongly, the laity fear constipation and naturally take what they are taught to believe is the cheapest and simplest course for its relief, self-drugging by means of saline cathartics or the extensively advertised purgative mineral waters. This habit is responsible for much of the distressing spastic constipation that exists, and its accompanying neurasthenia. The advertisement and sale to the laity of such a nostrum as “Sal Hepatica” can only increase these evil results and the physician who aids and abets the evil by using the preparation should reflect whether he is thereby not only encouraging a fraud on the public but also, what is even worse, helping to impair the public health.”

It is recommended that this report be authorized for publication in order that physicians may know the extent to which they have been made to act as advance agents for “patent medicines.” It is hoped its publication may suggest to those who in thoughtlessness have recommended Sal Hepatica, that they go to their materia medica and renew acquaintance with the host of simple and efficient laxative salts which are available—​magnesium sulphate, sodium sulphate, sodium phosphate and the palatable effervescing preparations of these which the Pharmacopeia provides—​effervescent magnesium sulphate (Magnesii Sulphas Effervescens, U. S. P.), effervescent sodium phosphate (Sodii Phosphas Effervescens, U. S. P.).​—(From The Journal A. M. A., Feb. 7, 1914.)

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