A Layman
THE tale of disaster and the sinister potentialities which can be sensed in the products of chemical research give ample cause for evil foreboding. Experience is already sufficient to justify further precautionary measures. The right of each medical man to prescribe anything which he deems advantageous to his patient is one that must not lightly be set aside. The time cannot be far distinct, however, when legislation will limit the sale of substances for internal use more strictly than in the past, and this will inevitably curtail the privileges of medical prescription.
It would seem reasonable to insist that no new substance be offered to or prescribed for the public as a medicinal substance until it has been tested thoroughly for toxicity, cumulation of drug, cumulation of main effect or of un- desirable side actions, and for common animal idiosyncrasy in accordance with some strict and discriminating procedure laid down by a competent official authority. The sale of new drugs which fail to pass the tests should be prohibited. Drugs eventually exhibiting after wider use a tendency to provoke serious idiosyncratic reaction could be withdrawn if it were judged that the advantages secured by the drug were insufficient to compensate for the catastrophes associated with its use.
It is difficult to see why the prescription of drugs like amidopyrine and cinchophen should be permitted for another moment in the face of the numerous fatalities on record. The relief of minor pain afforded by amidopyrine is a poor exchange for the malign symptoms of agranulocytosis. The doubtful benefits of the increased urate elimination of cinchophen therapy are no adequate recompense for necrosis of the liver. On the other hand, the saving of life and health effected by quinine is of vastly greater importance to malaria-ridden communities than the evils which it precipitates through idiosyncrasy, and the benefits conferred by neoarsphenamine completely outweigh the calamities occasionally following its injection.
A still stricter view can be taken of the situation, and it might seem to be in the best interests of the nation that the sale of any new drug should be prohibited unless it could be shown to possess some substantial therapeutic advantage over those already in service.
The justice of subjecting a whole community to the risk of idiosyncrasy during the exploitation of a new drug which merely copies or slightly modifies the action of an earlier one is at least debatable. In the absence of Government action these are matters which must continue to be referred to the conscience and scruples of the individual practitioner.
