Tag Archives: PhRMA

The Medicine Cabinet of Dr. Caligari


In the 1920 horror film “The Cabinet of Dr. Caligari,” the mysterious Dr. Caligari arrives at a carnival with a cabinet whose contents ultimately cause mayhem, madness, and murder.

In our modern-day editorial offices, a series of display cabinets has suddenly arrived in a side corridor—cases whose colorful contents once had much the same effects as the cinematic Dr. Caligari’s cabinet.

Photo by Terry Rudd

The mysterious cabinets contain antique bottles of medicinal magic, including these pre-modern marvels:

  • Who needed biologics when you had Yohn’s Rheumatic Elixir, “An Infallible Cure for Rheumatism, Lumbago and Gout”?
  • The 18th Amendment probably went down easier with Dr. Fenner’s Golden Relief, containing “Alcohol 65%, Ether 22 minims, Chloroform 5 minims, Capsicum, Turpentine, Ammonia,” and several other Prohibition-relieving compounds.
  • Chemoprevention was as simple as a spoonful of Dirigo Bitters and Blood Purifier: “A Preventive of Cancer.”
  • And finally, Parke-Davis & Co. discovered what Ponce de Leon futilely scoured Florida to find: “Life-Everlasting,” featuring the apparently immortality-inducing agent Gnaphalium polycephalum.

These historical artifacts actually belong to our corporate cousins who cover the pharmaceutical industry. But on some level, they belong to us all, a bottled legacy of medicine’s sometimes perilous evolution.

The medicine cabinets offer a rare glimpse back into the Valley of the Shadow of Death and Snake Oil. They’re reminders that we haven’t been climbing the mountain of medicinal progress as long as we might think.

In a time when a routine case of acute otitis media practically autogenerates an amoxicillin script, it’s easy to forget that many of our parents lived their childhoods in the deep shadows of a pre-antibiotic Dark Age. It’s hard to remember that the politically disparaged words “government regulation” once weren’t even in the pharmaceutical vocabulary, with painful results for millions. It wasn’t so long ago that our well-meaning physician ancestors chipped away at disease with the pharmaceutical equivalent of stone tools.

At best, those cabinets’ antique contents did little for their users. At worst, they were products from the closing moments of a millennia-long medical era that spawned the phrase “The cure is worse than the disease.”

Medical practice and the drugs upon which it relies have escaped their Dark Ages. From the antibiotic I’m giving my AOM-afflicted 7-year-old to the antiretroviral revolution in HIV treatment, scientifically tested and government-approved pharmaceuticals have helped create a world of health and longevity inconceivable a century ago.

Certainly, its snake-oil ancestors’ mortal sins don’t excuse the shortcomings of today’s pharmaceutical industry. Or those of the industry’s sometimes fallible regulators. But while we work ourselves into a righteous dudgeon over the influence of pharmaceutical industry funding or clinical trial obfuscation, or point fingers over imperfections in federal government oversight, we might want to take a moment to look back down the medicinal trail.

And remember how far we’ve come from the madness of those Caligari-esque medicine cabinets.

—Terry Rudd


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Filed under Drug And Device Safety, Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, Health Policy, IMNG, Infectious Diseases, Internal Medicine, Pediatrics

Just Three Republicans?

From “Prospects For Bipartisan Health Reform,” a breakfast conference at Union Station in Washington, and the Senate Finance Committee mark-up of its health reform plan in the Hart Office Building:

Quick question: How many Republicans are likely to sign on to the health reform package now making its way through the Senate?  Apparently, only three, if you believe the prognostication offered by an august group of Washington insiders this morning: former Louisiana House Member Billy Tauzin (now CEO of the Pharmaceutical Research and Manufacturers of America); Ron Pollack, executive director of the advocacy group Families USA;  and John Rother, executive vice president for policy and strategy at AARP.

The Pontificating Panel/Photo by Alicia Ault

The Pontificating Panel/Photo by Alicia Ault

Former Senate majority leader Tom Daschle, whose Bipartisan Policy Center hosted the breakfast, was even less sanguine.  He said maybe two Republicans might cross their GOP leaders to back a reform package.

Mr. Daschle may be more in the know.  After all, as the Washington Post recently reported in a front page story, he occupies one of the most prominent seats at Tosca, Washington’s newest power lunch spot.

But it certainly doesn’t require a crystal ball or longtime inside-the-beltway chops to discern the lack of bipartisanship.

Just a few blocks away, the Senate Finance Committee had begun the second day of deliberations on its draft reform plan.   It was not pretty.  Republican amendments were being struck down with impunity by the Democratic majority;  Democrats’ amendments were largely adopted by the same majority.

Chairman Max Baucus (D-Mont.) struggled to rein in a near-mutiny incited by Sen. Jim Bunning (R-Ky.) over whether the committee was moving too fast.  (The same Jim Bunning who was caught napping during the first day of mark-up.) Sen. Olympia Snowe (R-Maine), the chairman’s lone Republican supporter after almost three months of negotiations, jumped ship and joined with Sen. Bunning in condemning what she called an illogical and improper rush.

Sen. Bunning’s attempt to delay a vote  was being echoed across the Hill. Or maybe his amendment — which would have required the legislation to be posted and a Congressional Budget Office score to be in hand before the committee voted — was an echo of what was happening elsewhere, as House and Senate Republicans vociferously pushed for passage of a bill that would require all legislation to be posted online or otherwise made public at least 72 hours before a floor vote.  See Minority Leader John Boehner’s release here and Sen. Lisa Murkowski’s YouTube video here.

Sen. Baucus tried to muzzle his Republican colleague several times, but committee member Orrin Hatch (R-Utah) interceded and Sen. Bunning got his say.  In the end, a Baucus-led amendment passed; it was a slight variation on the Bunning theme, requiring that the panel make its bill public 72 hours before it voted.

But it left a sour taste in Republicans’ mouths.

The sausage-making is getting bloodier.

How many Senate Republicans do you think will vote for the final health reform package? Take our poll.

— Alicia Ault (on Twitter @aliciaault)
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Filed under health reform, Practice Trends

Indecent Disclosure?

From the Digestive Disease Week, Chicago.

Walking around McCormick Place this week, one was struck by what was — and was not — in evidence, given all the hoo-ha over conflict of interest in medicine these days.  In the last few years, attendees were heaped up with purple-festooned items emblazoned with “Nexium“, the ubiquitous “Purple Pill” that is probably one of the most over-prescribed pharmaceuticals in America.  

Where have all the sponsors gone?/Photo by A. Ault

Where have all the sponsors gone?/Photo by A. Ault

But this year, there was a severe shortage of gee-gaws, both at the registration desk and in the exhibit hall.  I mean, not a single squeeze toy, pen or post-it note pad.  The official DDW bag was a chic black cotton number.  No drug company names, no embarassing slogans, just “DDW” and the cryptic acronyms for the four sponsoring professional societies.

Dianne Bach, DDW’s industry liaison, said the societies did not have any official new sponsorship policy, but that they had decided to follow the Pharmaceutical Research and Manufacturers of America guidelines on industry support that went into effect in January.  That means that sponsorship of lanyards, carry bags, ID tags, pens, and the like were out.

DDW still had to offset that lost revenue, however.  The organization determined that drug company sponsorship of shuttle buses was OK.  And, for the first time, says Ms. Bach, DDW allowed large banners in the convention center hallways.

Purple banner/Photo by A. Ault

Purple banner/Photo by A. Ault

Still, DDW’s addressing of the conflict issue is a far cry from moves made by other professional societies. The American Psychiatric Association recently said it would no longer allow industry-supported symposia at its annual meeting.  DDW, however, has no plans to end those off-site seminars, says Ms. Bach.

And then there’s the matter of speaker disclosures.  DDW compiled a list of presenter disclosures, but don’t look for it in print.  The organization decided that at 180 pages, an on-line only version would be cheaper. 

At many sessions I attended — and i heard the same thing from a few other reporters — speakers only made glancing reference to their conflicts.

Now that’s what I’d call an indecent disclosure in this day and age. 

— Alicia Ault  (on Twitter @aliciaault)

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Filed under Family Medicine, Gastroenterology, Internal Medicine, Practice Trends