THE HYPOPHOSPHITE FALLACY

An Example of the Perpetuation of a False Theory by Advertising

A false therapeutic notion born of speculation soon dies a natural death if exposed unsupported to the cold world of facts, but when nursed by commercial interests it may be kept alive for generations. Interesting examples of this, to name but two or three, are the misconceptions perpetuated during the past half century concerning “lithia,” the “natural” salicylates and the hypo­phos­phites.

Take, for instance, the lithia delusion. The supposed solvent powers of lithium compounds for uric acid were soon disproved to the satisfaction of scientists, but proprietors of lithia waters and nostrums for gout and rheumatism still harp on the old string and utilize long-exploded theories. Take, again, the alleged superiority of “natural” to “synthetic” salicylates. In spite of experimental proof to the contrary, proprietary interests have been able for twenty years to persuade a large part of the medical profession that the effects of pure salicylic acid made artificially differ from the effects of the same substance obtained from natural sources.

The altogether undeserved continued popularity of hypo­phos­phites affords a striking example of the influence of advertising in perpetuating therapeutic error, for hypo­phos­phites are given on a theory long since disproved. It may be interesting to trace the origin and history of the theory on which the practice of prescribing the hypo­phos­phites is founded. The early part of the last century was prolific in chemical discoveries, and, as a corollary, in chemical theories of disease. Many of the theories arose from the hasty application of the chemical properties of new elements and compounds to the explanation of the processes in the living body, without due consideration of the conditions prevailing in the animal organism.

THE ELEMENT PHOSPHORUS

The element phosphorus is eager for oxygen and readily oxidizable. When taken into the system it acts as a violent poison, and, in view of this, it was at first supposed—​although the supposition was based on no scientific data—​that it would prove to be a powerful therapeutic agent when given in minute doses. In its elementary form, phosphorus is difficult to handle, and therefore not convenient for use. Hence it was natural that a compound should be sought which could be used as a substitute for the element.

Broadly speaking, phosphorus forms three classes of salts varying in the degree of oxidation: the phosphates, containing the most oxygen, the phosphites, containing less, and the hypo­phos­phites, least of the three. The phosphates, being saturated with oxygen, undergo little change in the body, and because of this were thought to be of little value in therapeutics. The phosphites contain less oxygen, are unstable and are not used in medicine. The hypo­phos­phites, containing still less oxygen, stand nearest to elementary phosphorus and are easily decomposed and readily oxidized to phosphates. Hence the theory that the hypo­phos­phites would furnish an admirable source from which to obtain the action of the element phosphorus.

CHURCHILL’S THEORY

The hypo­phos­phites were introduced into medicine about 1855, as a substitute for elementary phosphorus by a Dr. Churchill of Paris, and later of London, who advocated their use as a specific remedy for consumption. Churchill conceived the theory that phthisis is caused by a lack of oxygen in the tissues; he therefore sought an agent capable of increasing oxidation. He was led to the use of hypo­phos­phites for this purpose on the supposition that phosphorus exists in the organism as a biologic element in a lower degree of oxidation than the phosphate. He supposed that this form of phosphorus acts by its chemical affinity as an initiatory agent in attracting and utilizing the inspired oxygen. He believed that when this form of phosphorus, which he called the “phosphide element,” is deficient in quantity (because it had been oxidized into phosphate, or because the supply from natural sources was deficient), the degree of oxidation of the tissues is less than normal. Therefore he advocated the use of hypo­phos­phites to supply the lacking oxidizing constituent. He believed this “phosphide element” not only to be essential for the oxidation of the tissues, but also to be the source of energy of the nervous system.

THE FACTS

The theory was a pretty one; the facts, however, did not support it. Subsequent investigations indicate that instead of consumption being due to a lack of oxygen, there is in that disease really an increased oxidation; in other words, the respiratory exchanges in this disease are exaggerated. The existence in the system of a form of phosphorus less highly oxidized than the phosphates is unproved. No evidence has been produced to show that phosphorus acts as an energizer of oxidation. There is no proof that the hypo­phos­phites enter into general metabolism or affect disease processes in any way. Not only is there no scientific evidence for the utility of the hypo­phos­phites, but science has long since demonstrated their worthlessness.

In 1895 Boddaert[153] published researches showing that hypo­phos­phites are rapidly eliminated through the kidneys unchanged. Similar results have been reached by Paquelin and Joly, who attributed to the hypo­phos­phites only the action of diuretics. In 1901 Massol and Gamel[154] found by animal experimentation that the hypo­phos­phites did not act as diuretics, but that the hypophosphorous acid was completely eliminated in the form of sodium hypophosphite. The urea was not increased and the relation of urea to total nitrogen remained the same. Their results indicated no increase of oxidizing actions within the system. Finally, Massol and Gamel examined the urine of patients taking hypo­phos­phites and found the same conditions: the results were the same as in the experiments on animals.

PROPRIETARY THERAPEUTICS

In spite of these facts the hypo­phos­phites continue to be employed by many practitioners. Why? Because the theory, being plausible at the time when such chemical theories were popular, gained a certain recognition and was accepted without scientific investigation. Thus the hypo­phos­phites came into use. It was not long before they were taken up by certain manufacturers, and the theory on which their use was based became a commercial asset. As a result the theory, which uncommercialized would have died of inanition, was kept alive by continued advertisement.

The manufacturer of proprietaries having settled on a plausible theory on which to sell his products has no further need for science. Thus, while these theories are no longer to be found in accredited text-books, they are still preached by the proprietary interests. An elaborate pamphlet on “Iodine and Phosphorus,” containing statements which are known to be false, is one firm’s text-book supplied to physicians to-day, and contains long quotations from Dr. Churchill’s writings of sixty years ago. This book contains no intimation that these theories have been overthrown. It is poor economy to waste money in changing literature when the old theories and the old plausible reasoning will sell goods just as well. Consequently the old errors are drummed into those physicians who are willing to read their physiology from the neat monographs of proprietary literature and to sit at the feet of glib salesmen who expound to them the proprietary theory of therapeutics.​—(From The Journal A. M. A., April 25, 1914.)