Popular Science Monthly/Volume 70/May 1907/Drug Abuses, their Effects on the People

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DRUG abuses have become so grave that at last the medical profession is compelled to correct them. The public should learn clearly our mutual positions in the proper and improper use of drugs, which are chemical substances found useful or necessary to combat the effects of disease. They are demanded in many instances where no other known means are available. It is obvious, however, that misuse is capable of vastly greater harm than their absence.

Certain 'schools of medicine' are recognized, differing chiefly in the opinions entertained as to what drugs shall be employed and what effects are to be expected from them, as well as the manner of their administration. The 'schools' most prominent are two; the regular profession of medicine and that of homeopathy. Though starting from the same basis, i. e., long experience in the selection and preparation of remedial substances, begun in the earliest periods of history, a time came when revolt arose from the existing confusion. Hahneman, a vigorous dogmatic thinker, determined to change the point of view hitherto entertained, and in the process accomplished a number of important results. The chief of these was in the preparation of drugs, and in the amounts administered. He evolved a number of opinions and many shrewd conjectures, some fanciful and some based on careful observation, as to drug effects, direct and indirect. To-day, after a century of critical scrutinization of recorded principles, these two schools differ on essential points inconsiderably. The vital point is that drugs in one form or another are popularly believed to be endowed with enormous powers for good. History encourages this belief, especially when one considers the discovery of cinchona and certain specifics, such as mercury, and later the antitoxins. The utility of drugs, remedial substances foreign to the economy, is of the highest order in many forms of disease. In the future when the principles of their action are fully understood, both from experience and physiology, they will continue to exert even more definite usefulness. Some hygienic and other measures are capable of replacing them, many of supplementing them, but in certain grave emergencies they are absolutely required. To omit their use, and expect to discharge full duty to the sick, is a failure to furnish something essential, permitting a person endangered by the tyranny of disease to suffer neglect. It is conceivable that in the future an adequate growth in knowledge of the inherent resources of the organism may lead to their omission; but that day is not yet come.

Wherever there is demand it is met by supply. An overmastering desire of most people is to secure the largest material benefits for the least money. Where a physician is consulted and medicines are ordered, these must be paid for in addition to the fee for advice, hence all manner of devices are employed to reduce the cost. The fact is too often overlooked that only by the direct application of skilled advice to the instance, then a suitable remedy being chosen, is safety to be secured. The business man might otherwise as well depend on law primers and omit to consult skilled attorneys. The unwarrantable repetition of prescriptions emanating from physicians of admitted wisdom, and the recommending of these to friends and neighbors gratuitously, are obvious abuses of what is essentially an economically scientific procedure.

As commercial enterprises grew in complexity and breadth of scope, these 'favorite prescriptions' began to be manufactured, advertised and distributed in wholesale fashion. People were encouraged to believe that they might thus secure medical combinations of great power at first hand, and the apparent but false economy was broadly welcomed. These preparations were made agreeable, or at least acceptable, and any one could secure a bottle full of promising potentialities guaranteed to overcome whatsoever ills might occur, real or fancied. Hence arose two classes of drug combination, the nostrum, offered directly to the consumer, based on the commercial principle of exploiting 'favorite prescriptions,' and the proprietary preparations offered to the physician, purporting to be improvements, the product of laboratory researches, constituting true chemical discoveries or refinements and specializations in scientific manufacture. As to the former (the nostrum), it is impossible to see, viewed with the utmost charity, any reason for its existence. Of many of the proprietary preparations, it must be admitted that they evidence excellent advances made by the reputable drug manufacturers, who devote much money and scientific effort to the perfection of methods and products. They have, in many instances, however, transgressed their just prerogatives and invaded the territory of the physician. They make diagnoses, teach us pathology and instruct us how to prescribe.

The sales of nostrums have grown so large as to constitute an overwhelming proportion of all medicines consumed. Their unguided use induces drug habits, fetish worship, incalculable harm.

The educated experienced practitioner of medicine has been forced by the reckless drug consumption thus induced to take not only a secondary position, but is placed low in the scale of guiding influence, in legitimate rewards. The sphere of the physician is of largest practical utility to the community. He it is who, by long years of close study, hospital teaching and personal experience, becomes gradually equipped to fill the responsible post of conservator of public and private health, of guide to the delicate human mechanism when disordered. His problem is a complex one for which he must furnish the highest qualities of character, wisdom, tact, sympathy and personal kindliness. He is the one who, even in those situations of gravity when the onslaughts of disease can not be stayed, comes closer to the heart, the soul and person than even the man of God. He should be (and in this as in other ways he seldom fails) in all respects a man, typifying the most estimable advisory qualities of friend, father, brother. No household is safe without a wise family physician in whom the members can repose confidence. He can, and does, furnish far more than medical advice; he is the counselor in a thousand directions, whether in illness, sorrow, domestic catastrophe, mental shock, perils of countless sorts and degrees. He can only display his resourcefulness, his manifold capacities, if he be permitted free access to the household to enable him to foresee, warn and thus prevent those calamities which too often can not be cured. It is an inconsiderable part of his duties to administer drugs, though these are among his keenest weapons. He should possess the fullest knowledge of their uses and employ them with skill and timeliness.

How far could a crew of bankers, of clergymen, of merchants guide and use a man-of-war? What sort of pictures could a man untrained in pictorial art paint, were he provided with the full accoutrements of a skilled artist? How long would a child alone continue to live in a butcher shop stocked full for Christmas feasting? These analogues are mild compared with that of an ailing man or woman turned loose in a chemist's shop to select remedies unaided. Yet many people take advice and swallow drugs, deadly in ultimate intent, incited thereto by each other, by the newspapers, by alluring labels on the bottles, and still regard themselves as shrewd. They often do worse, if, failing good effects from these nostrums (and provided they survive) turning to charlatans, who trade upon human credulity, themselves not realizing that sick bodies always enshrine disordered minds.

The sphere of the physician is not that of a merchant selling wares; he is the scientific and practical guide in times of physical danger. His duties and responsibilities are theoretically, but not practically, understood. The public expects of him who guides the helm in times of disease and threatened death ethical qualities which he seldom fails to furnish. If in his best judgment drugs are needed, he it is who should select and change. He may be less wise than he might, or even than he is estimated, but assuredly he is vastly better fitted at all times to direct and control the course of physical derangements than even the wisest layman.

Commercial principles are comprehensible by all; financial success is obtrusively tangible. A firm earning enormous sums by the sale of remedies is naturally supposed to be offering a valuable product. The professional spirit, the ethical, the scientific principles on which action must be based to be intelligently successful, are thus obscured. The great proportion of people of this country estimate the scientific practitioners of medicine, equipped as they are with years of patient scientific self-sacrificing education, as of small account compared with the material achievements of the great factors of nostrums and proprietary medicines. The sphere of acquired wealth, in comparison with this quiet faithful service, is obvious, speaks a comprehensible language.

The members of our profession in the concrete have quietly submitted to a domination at the hands of these manufacturers which is no less than contemptible. In matters of politics 'money talks,' The great power of the country resides in the public press. With them money also talks. Advertisements are paid for which alone aggregate sums close to the total of the gross earnings of legitimate practitioners. Hence naturally are induced alliances, defensive and offensive, whereby the power of the great drug houses becomes increasingly intrenched for good or evil.

The members of a learned profession are thus made to appear of little account. When they protest, as individuals, their voice is overborne by platoon fires of pseudo-scientific, advertising jargon till most of us become dazed and all but ready to capitulate before we can place our evidence on record, or even get a hearing.

Incredible sums of money are spent by the great drug manufacturing houses to make and hold their power. They are almost impregnable, but not quite. No physician in America earns such an income as is enjoyed by many individual members of these firms who live like royal princes, leaving at death fortunes which, when subdivided, suffice for generations of affluence. Yet the cure of all this peril is simple, but by no means easy of attainment. Physicians should act in concert and consistently. They should acquaint themselves accurately with the facts and educate the public to know where and how drugs may be best used, and especially point out where they should not.

First let us, every one, learn and make clear to the public at all times what are the effects of nostrums. Can they exercise any beneficent purpose? Emphatically no. What good end can they serve? It is difficult to see one. What possible advantage can accrue from this obtrusion of drugs in attractive shapes upon the receptive consciousness of the community? It may be claimed that every man has the right to make free choice of the treatment for his bodily ailments. Yet the practise of self-medication is one of the most deplorable relics of the dark ages when the treatment of bodily ailments was confused with matters of conscience.

Consider for a moment the gravity of a peril for which it is difficult to see a remedy. These aggregations of capital must sell to maintain themselves. If the market is oversupplied they must make another market. If physicians do not wish to use such preparations as they furnish, they must be induced to do so, their hands must be forced. If the manufacturer sells directly to the public, via the druggist, every device must be employed to increase retailing to the consumer. If a man has no ailment he must be taught to think he has one. If he has recovered from an ailment he must forsooth thereupon be made fat or thin. Women are educated to believe they require a host of remedial articles, in reality quite supererogatory. Babies who would thrive best by instinctive maternal teachings are made to appear in need of special foods, soothing agents, etc. In short, healthy folk are taught to become hypochondriacs. All this merely to furnish a brisk market when selling has grown languid.

One closing thought we commend to all, especially to clergymen and religious folk. Can anything be more venal, more opposed to the fundamental principles of ethics, more an earning of money by encouraging misconceptions of our physical and mental feebleness, than many of the ordinary advertisements in the public press of remedies, of drugs, or other semi-medical materials, waters, instruments, etc.? If these bold emphatic advertising statements contain some elements of truth they are too often grossly overstated. The sale of 'get well quick' remedies for venereal diseases causes a confidence unwarranted. Thus thousands of innocent women are infected, rendered invalids for life.

There is only one safe rule when in trouble. Seek expert, honest, reputable counsel and be guided by it. This is of paramount importance when the body is disordered because then also is the mind, the judgment, likewise impaired.