SECRETOGEN
Report of the Council on Pharmacy and Chemistry
The Council has authorized publication of the following report dealing with two internal secretion specialties—Secretogen Elixir and Secretogen Tablets—to call attention to the unfounded and extravagant claims made for this class of products.
W. A. Puckner, Secretary.
Test tube experiments show that pepsin hydrolyzes proteins in acid solutions; that pancreatin digests protein in alkaline liquids, and that diastase converts starch into sugar. Based on these facts, it was assumed that these ferments would aid digestion. This assumption was correct if limited to certain cases of dyspepsia in which it can be shown that certain ferments are absent or deficient. But this limitation was not realized or remembered; on the contrary, the indiscriminate use of digesting ferments in all kinds of cases of indigestion became widespread and still continues, although to a less extent. Herein lies the great disappointment that has followed the use of these ferments.
More recently hormones were discovered, and while their importance has not been fully worked out, it has been assumed that they are responsible for the secretion of digestive ferments, and that in their absence this secretion fails. Without waiting for proof of this assumption, that is, that digestive failure is due to lack of hormones, proprietary medicine promoters are already placing on the market various secretion specialties.
As an example of this new class of specialties and of the unfounded claims made for them, your referee presents the following report on Secretogen Elixir and Secretogen Tablets offered to physicians by the G. W. Carnrick Company.
Secretogen Elixir is said to contain pancreatic secretin obtained from the duodenum with 1⁄10 of 1 per cent. of hydrochloric acid. Secretogen Tablets are said to be prepared from pure secretin and succus entericus obtained from the epithelial cells of the duodenum. The claims for Secretogen are based on the physiologic action of secretin as described by various observers. To determine whether these claims are justified it becomes necessary to review the evidence advanced to prove that secretin stimulates the digestive glands.
Secretin is a hormone, a chemical substance produced by the action of hydrochloric acid on a previously formed substance, “prosecretin,” contained in the cells of the intestinal mucous membrane, especially of the duodenum. Secretin is absorbed by the blood and carried to the pancreas, liver and intestinal mucosa, which are thereby stimulated to produce their characteristic secretions, namely, bile, pancreatic juice and succus entericus. When secretin is injected into the blood, it causes an increase in the flow of these secretions. Some observers have claimed that secretin is absent in cases of diabetes in which the pancreas is still found normal. Wentworth[80] reported several cases of marasmus in which he found no evidence of prosecretin. This deficiency, he believes, is the cause of this disease.
The Carnrick Company, adopting the foregoing views, namely, that secretin is necessary to secure the normal action of pancreas, liver and intestine, as proved, placed on the market their specialty “Secretogen,” to take the place of the missing secretin.
The foregoing conclusion cannot, however, be sustained. There are numerous cases in which no hydrochloric acid is produced in the stomach and hence—as it is produced by the action of hydrochloric acid—no secretin can be produced in the intestine. Yet in these cases the pancreatic juice and bile are secreted in normal amounts and digestion goes on normally after the food leaves the stomach. In such cases the pancreas and liver must be stimulated to secretion by some other mechanism than secretin.
The proof that the absence of secretin is characteristic of diabetes or of marasmus is not yet available. Sweet and Pemberton[81] found that many circumstances interfered with the extraction of secretin, so that the mere failure to obtain it in a given case is not proof of its absence, unless the various inhibiting influences are given due consideration. The conclusions reached by these authors are that “the evidence so far adduced that secretin is absent in some varieties (of diabetes) does not seem conclusive,” and that “the specific absence or deficiency of secretin in marasmus seems to remain as yet unproven.”
The favorable reports of Moore[82] in regard to the use of secretin in diabetes are not confirmed by the experience of Foster[83] in five cases, or by the case reported by Dakin and Ransom.[84]
In regard to the use of secretin in intestinal disorders, the G. W. Carnrick Company refers to an article by J. W. Beveridge.[85] An examination of this article shows it to be unscientific and uncritical. The author presents four cases to “demonstrate the peculiar potency exercised by secretin.” Of the first he says:
“Stomach was dilated, food delay, seventy-two hours; hyperacidity, vomiting daily, five to twelve times, urine high specific gravity, over 3 per cent. urea, trace albumen.”
The patient improved somewhat after gastro-enterostomy with removal of the gallbladder; the vomiting ceased, but the stools continued clay-colored and the high urea output still kept up. Secretin was given, and after this the report continues:
“The stools became normal in color at the end of the second month, weight gradually increased until 1223⁄4 pounds was reached, and the urea is now normal, averaging about 1 per cent.”
This case is offered to prove the absence of secretin and its effect when given by the mouth. As evidence of hepatic insufficiency the author apparently relies on the color of the stools, and for pancreatic insufficiency he cites the high urea output. He claims that when the pancreas does not furnish an efficient secretion, the proteins of the food fail to be converted into amino-acids, and instead, raise the percentage of urea. Consequently, he concludes that a high percentage of urea indicates the absence of secretin. It is usually held that a high percentage of urea depends on two factors, ingestion of a large amount of protein and concentration of the urine. The author gives no data as to the amount of albuminous food, the amount of urine, or whether the percentage of urea was learned by examining a single specimen or the total quantity for twenty-four hours. The mildest judgment that can be passed on such clinical data is that they are totally inadequate. Without doubt the percentage of urea could have been reduced to “normal” by causing the patient to drink water freely. The remaining cases show similar hasty conclusions from insufficient data, rendering them worthless as evidence.
The G. W. Carnrick Company introduces a number of testimonials as to the value of Secretogen. These testimonials are similar to all testimonials. They include no evidence of careful diagnosis, and present an uncritical estimate of the results. They show that the writers have given Secretogen Elixir or Tablets indiscriminately in almost the whole range of digestive disorders, in nephritis, neuralgia, liver disease and gallstones, exophthalmic goiter, neurasthenia, epilepsy, etc. As dependable evidence, these testimonials are not worthy of consideration.
A rational basis for the therapeutic value of Secretogen is lacking for the following reasons:
1. No evidence has been presented that the absence of secretin is a cause of gastro-intestinal diseases. It is usually present, and if not present, as in achylia gastrica, there is evidently some compensating arrangement by which the pancreas is stimulated to perform its regular functions.
2. There is no evidence that secretin in any form is physiologically active when administered by the mouth.
REFERENCES
Fleig, M. C.: Action de la sécrétine, Arch. gén. de méd., lxxx, 24.
Charles, J. R.: Treatment of Diabetes with Secretin, Bristol Med.-Chir. Jour., September, 1906; Med. Press and Circular, Nov. 21, 1906.
Meltzer, S. J.: Animal Experimentation in Relation to our Knowledge of Secretions, Especially in Internal Secretions, The Journal A. M. A., May 7, 1910, p. 1506.
Wentworth, A. H.: The Cause of Infantile Atrophy, Deduced from A Study of Secretin in Normal and Atrophic Infants, The Journal A. M. A., July 20, 1907, p. 204.
Bambridge and Beddard: Guy’s Hospital Reports, 1907, lxi, 161.
Enriquez and Hallion: Nuevas nociones sobre la digestion. Secretin, Importancia fisiologica y patologica, Transactions of 14th Int. Med. Congress, Madrid, 1904.
Enriquez: La Sécrétine Médication acide duodénale Stimulation de function sécrétiniques chez l’homm., Rev. de. thérap. méd.-chir., Paris, 1904, lxxi, 187.
—(From The Journal A. M. A., May 1, 1915.)