PROTEOGENS

Commercial Therapeutics [P]

A report of the Council on Pharmacy and Chemistry that appears elsewhere [253] in this book deals with another attempt to foist on our profession a series of essentially secret preparations whose therapeutic value has not been scientifically demonstrated. Grotesquely extravagant claims are advanced as to the therapeutic potency and range of action of substances of whose nature and effects we have no trustworthy information. Physicians are advised to use—and many undoubtedly are using—these alleged remedies in the treatment of diseases in which delay in the proper kind of treatment may be of the greatest danger to the patient. As stated, there is available no reliable information regarding the effects of these substances when they are introduced in the human body. They may have no effect whatever, or they may produce more or less direct injury; in either case, there is the chance that damage, even irreparable to the patient, may result because rational treatment is withheld.

If we accept the statement that the preparations are largely vegetable proteins, it is a fair inference that, under certain conditions, they may cause a febrile reaction of the same general nature as that caused by other foreign proteins when injected into the body. We know that such reactions are not without danger and that the treatment of certain infections by induced reactions to foreign proteins is strictly an experimental procedure to be undertaken only under very special conditions. There is, therefore, no known valid reason why a physician should assume the responsibility for using these alleged remedies in the treatment of his patients; there is a very obvious reason why he should not—the therapeutic instructions of “the House of Merrell, always interested in the progress of plant therapy” to the contrary notwithstanding. It is the old story of exploiting physicians through commercial pseudoscience; of trading on the credulity of the profession to the detriment of the public. As Osler [254] recently protested so vigorously:

Some time ago a pamphlet came from X and Company, characterized by brazen therapeutic impudence, and indicating a supreme indifference to anything that could be called intelligence on the part of the recipients. That these firms [manufacturing pharmacists] have the audacity to issue such trash indicates the state of thraldom in which they regard us. And I would protest against the usurpation on the part of these men of our function as teachers. Why, for example, should Y and Company write as if they were directors of large genito-urinary clinics instead of manufacturing pharmacists? It is none of their business what is the best treatment for gonorrhea—by what possibility could they ever know it, and why should their literature pretend to the combined wisdom of Neisser and Guyon? What right have Z and Company to send on a card directions for the treatment of anemia and dyspepsia, about which subjects they know as much as an unborn babe, and, if they stick to their legitimate business, about the same opportunity of getting information? For years the profession has been exploited in this way, until the evil has become unbearable, and we need as active a crusade against the pseudoscience in the profession as has been waged of late against the use of quack medicines by the public. We have been altogether too submissive, and have gradually allowed those who should be our willing helpers to dictate terms and to play the rôle of masters. Far too large a section of the treatment of disease is today controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudoscience.

What shall the profession do to protect itself against this humiliation—to throw off the credulity that extols pseudoscience and makes commercialized empiricism financially profitable? Osler says the remedy is obvious: “Give our students a firsthand acquaintance with disease, and give them a thorough practical knowledge of the great drugs, and we will send out independent, clear-headed, cautious practitioners who will do their own thinking and be no longer at the mercy of the meretricious literature, which has sapped our independence.” Excellent! But must humanity wait a generation? Why not stop this evil at once? The American Medical Association has provided the means whereby this can be done, if physicians will only make use of it—the Council on Pharmacy and Chemistry.—(Editorial from The Journal A. M. A., July 12, 1919.)

An Alleged Endorsement of Proteogens Repudiated

To the Editor:—I note in the issue of The Journal for July 12, a statement regarding the so-called “Proteogens” manufactured by the Wm. S. Merrell Company of Cincinnati.

My attention has been called to the fact that salesmen of this company have been exhibiting a letter purporting to show that this department has endorsed their products in the treatment of venereal diseases. The letter in question was written by a physician employed in one of the clinics conducted jointly by this department and the U. S. Public Health Service, and the stationery of the department was used without authority. The physician in question has made numerous efforts to recall the letter, but the Merrell people profess an inability to control its use.

I need not add that this department has not endorsed and will not endorse these products, and has no evidence that they are of any value whatsoever.

Allen W. Freeman, M.D., Commissioner of Health,
State of Ohio, State Department of Health.

—(Correspondence in The Journal A. M. A., July 26, 1919.)

The Manufacturer’s Protest and a Reply

To the Editor:—Allow us to direct your attention to several misstatements which appear in the letter signed, “Allen W. Freeman, M.D., Commissioner of Health, State of Ohio,” published in The Journal of the American Medical Association for July 26.

1. Salesmen of this company have not been exhibiting a “letter purporting to show that this department has endorsed their products in the treatment of venereal diseases,” as stated by Dr. Freeman.

2. The author of the letter has not “made numerous efforts to recall the letter, but the Merrell people profess an inability to control its use,” as stated by Dr. Freeman.

A physician employed in one of the clinics used our Proteogens Nos. 10 and 11 extensively and is still using them to a large extent in his private practice. He is a man of standing in the community in which he practices and is also a professor in one of the leading medical colleges in the state.

The letter in question cites the case of a man who had been under treatment for three years with 606, 914 and most of the other treatments in general use, and on August 31, a year ago, still gave a Wassermann test plus 4. He was given Proteogen No. 10, and by the middle of December the Wassermann was negative and the man was discharged as cured.

While this letter was written on the stationery of the Bureau of Venereal Diseases of the Department of Health, State of Ohio, it was written in the first person, and made no pretension in any way to being official nor was any such pretense made or authorized by the Merrell Company.

The author of the letter has not made “numerous efforts to recall the letter,” nor has the Merrell Company “professed an inability to control its use.”

The physician did ask that the letter be returned to him, and his request was complied with promptly.

[Then follows the full text of the letter in question. As its contents have no bearing on the question under discussion, it is omitted.—Ed.]

In over ninety-one years of honorable service as manufacturers of medicinal preparations, the Wm. S. Merrell Company has never endeavored to advance its interests through misrepresentation.

The Wm. S. Merrell Company,
Chas. G. Merrell, Pres.

[The letter above was submitted to Dr. Allen W. Freeman, Commissioner of Health of the State of Ohio. Dr. Freeman’s comments appear below.—Ed.]

To the Editor:—The plain issue of veracity raised in the communication of the Merrell Company must be settled on the evidence, which is unfortunately too voluminous to be published in full in The Journal. Copies of the correspondence in the case have been furnished the editor, and the originals are on file in the office of the state department of health in Columbus.

1. Whether or not the photographic reproduction of a letter written on the letter head of this department, and the distribution of copies to salesmen for display to physicians, was a conscious effort on the part of the firm in question to create the impression that the letter was an official one is perhaps a matter of inference. That it did create such an impression is evidenced by the letters of inquiry received from physicians who saw it.

2. The statement that the Merrell Company refused to return the letter is perhaps erroneous. They did apparently return the original letter but not the photographic copies which had been distributed to their salesmen. On May 22 the firm wrote as follows:

“A number of physicians who are in cooperation with both state and national bureaus of venereal diseases have been using our Proteogens with marked success and there are doubtless many letters carried by our salesmen—reports from some of these physicians.”

This was interpreted to mean that the firm had no method of knowing what letters were carried by their salesmen and was not responsible for them. Whether or not this interpretation is correct is again, perhaps, a matter of opinion.

The purpose of the original communication was to make plain to those of the profession who have already seen or might subsequently see the letter referred to that the communication was the expression of an individual and not of the Department.

A. W. Freeman, Commissioner.

—(Correspondence in The Journal A. M. A., Sept. 6, 1919.)

Details of the Alleged Endorsement of Proteogens

Our readers will remember the recent correspondence published in The Journal of July 26 and September 6, by Dr. A. W. Freeman, Commissioner of Health of the State of Ohio and the Wm. S. Merrell Co. The letters dealt with the use that had been made by the Wm. S. Merrell Co. of a letter, written on the official stationery of the Bureau of Venereal Diseases of the State Department of Health of Ohio, puffing one of the company’s proprietary remedies—Proteogen No. 10.

Dr. Freeman wrote to The Journal calling the attention of the profession to the use of this letter and explaining that the letter was merely the expression of opinion of an individual, and not an expression from the State Department of Health. The Wm. S. Merrell Co. took exception to certain inferences made in Dr. Freeman’s letter and in the course of a letter to The Journal regarding this, incorporated the contents of the testimonial letter. The Journal, in publishing the Merrell letter, omitted this testimonial on the ground that the contents of the letter had no bearing on the question under discussion.

We have now received a letter from the company protesting against this omission. The Journal, therefore, takes this opportunity of briefly restating such facts as it has been able to get regarding the entire matter and publishing the letter. The facts are as follows:

1. In February of this year a Cincinnati physician, Dr. C. J. Broeman, wrote to Dr. A. S. Horovitz relative to alleged results with Proteogen No. 10. The letter was written—without authority—on the official stationery of the Bureau of Venereal Diseases of the State Department of Health of Ohio.

2. The Wm. S. Merrell Co. had linen mounted photographs made of Dr. Broeman’s letter and distributed them to their Proteogen detail men. Accompanying these photographic copies was a communication to these detail men describing the photographed letter as one written by:

“... a Cincinnati physician who is now Acting Assistant Surgeon, U. S. Public Health Service, cooperating with the Bureau of Venereal Diseases of the Department of Health of the State of Ohio.”

3. The right hand top corner of the official stationery, as can be seen by the reproduction, bore the name of “James D. Bauman, Deputy Commissioner.” Dr. Broeman’s signature was rather illegible and could easily be mistaken, by those not knowing the handwriting of either man, for the signature of Deputy Commissioner Bauman. In at least one instance it was so mistaken, and the physician who was misled wrote to the Director of the Bureau asking whether the testimonial for Proteogen No. 10 which had been shown him by the Merrell detail man was really an official communication.

4. On May 15, 1919, Commissioner of Health Freeman wrote to the Merrell Co. stating that he had been informed that one of the Merrell representatives was using as an advertisement a letter bearing the letterhead of the Bureau of Venereal Diseases of the State Department of Health and what purported to be a report signed by “Mr. Bauman, Deputy Commissioner.”

5. On May 19, the Wm. S. Merrell Co. wrote Dr. Freeman that he was certainly mistaken in regard to the use of any “report signed by Mr. Bauman.” Dr. Freeman then sent to the company the letter he had received from the physician who had mistaken Broeman’s letter for an official letter by Bauman. Although it would seem that this letter and Commissioner Freeman’s protest should have made plain to the Wm. S. Merrell Co., the fact that the letter, incorrectly referred to as Mr. Bauman’s, was in reality Dr. Broeman’s, the company remained silent regarding its use of the Broeman letter and, on May 22, merely reiterated that there had been “no letter circulated by this company containing a testimonial of your Mr. Bauman.” On May 28 (six days later) the Merrell company sent to its Proteogen detail men another general letter, “for personal use of agents,” in which it again called their attention to the “photographic copy mounted on linen” of Dr. Broeman’s letter. This communication to the detail men also declared that it “has been suggested that the further use of Dr. Broeman’s letter might antagonize the State Department of Health” and, therefore the detail men were told to “discontinue using the photographic copy in question” and to return the photographs to the head office.

Reproduction (reduced) of one of the photographic copies sent out by the Wm. S. Merrell Co. to its Proteogen detail men to be shown to physicians. While the letter is a private one, it was written (without authority) on official stationery. Some physicians were misled into thinking it was an official endorsement of Proteogens. The Merrell concern denied any intention to mislead and claimed that it was interested only in bringing to the attention of physicians the contents of the letter!

Here, briefly are the bald facts in the case. The essential point at issue is whether these photographic copies of Dr. Broeman’s letter would or would not be likely—whether or not they were so intended—to mislead physicians into believing that the endorsement was an official one by the State Board of Health rather than an individual one. One can but wonder why, if, as the Merrell company so vehemently asserts, there was no intention of misleading physicians on this point, the company should have gone to the trouble and expense of photographing the entire letter, including the letterhead, rather than making typewritten or mimeographed copies of the contents of the letter.—(From The Journal A. M. A., Sept. 27, 1919.)

Dr. Broeman’s Final Report on Proteogens

To the Editor:—In the September 27 issue of The Journal my name was mentioned in connection with the Merrell Chemical Company’s “Proteogens” in the treatment of syphilis. The Merrell Chemical Company promised not to use my name at any time in connection with their “Proteogens” injection and they know that the use of my name has been distinctly against my wishes. I feel that in justice to myself, as well as the public, I should report the result of my experiments with their “Proteogens” in private practice.

In explanation I might say that I began the use of their “Proteogens” in April, 1918, and I feel that I now have enough data to give a complete report. I might say that all my results have been practically nil; particularly is this true in my cases of syphilis, which all had a four plus Wassermann reaction when I discontinued using this form of treatment.

Very truly yours,

C. J. Broeman, M.D., Cincinnati.