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(The list referred to follows:)

EXHIBIT A

MEMBERS OF THE PHYSICIANS' COUNCIL

Dr. Robert A. Aldrich, Department of Pediatrics, University of Washington

School of Medicine, Seattle, Wash. Dr. John A. Anderson, Department of Pediatrics, University of Minnesota, 1460

Mayo Memorial, Minneapolis, Minn. Dr. Henry L. Barnett, Department of Pediatrics, Albert Einstein College of

Medicine, Eastchester Road and Morris Park Avenue, New ork, N.Y. Dr. Allan M. Butler, Metropolitan Hospital, Detrit, Mich. Dr. David H. Clement, 240 Bradley Street, New Haven, Conn. Dr. Harry F. Dowling, Department of Medicine, University of Illinois College

of Medicine, 840 South Wood Street, Chicago, Ill. Dr. Louis S. Goodman, Department of Pharmacology, University of Utah Col

lege of Medicine, 210 Medical Building, Salt Lake City, Utah. Dr. Lee Forrest Hill, 3200 University Avenue, Des Moines, Iowa. Dr. L. Emmett Holt, Jr., Department of Pediatrics, New York University Medi

cal Center, 550 First Avenue, New York, N.Y. Dr. James G. Hughes, Department of Pediatrics, LeBonheur Children's Hos

pital, 848 Adams, Memphis, Tenn. Dr. C. Henry Kempe, Department of Pediatrics, University of Colorado Medical

Center, 4200 East Ninth Avenue, Denver, Colo. Dr. Preston A. McLendon, 2146 Wyoming Avenue NW., Washington, D.C. Dr. Charles D. May, Department of Pediatrics, Bellevue Hospital, New York,

N.Y. Dr. Herbert C. Miller, Department of Pediatrics, University of Kansas Medical

Center, Kansas City, Kans. Dr. Edward L. Pratt, Department of Pediatrics, University of Texas Southwest

ern Medical School, 5323 Harry Hines Boulevard, Dallas, Tex, Dr. Walter Modell, Department of Pharmacology, Cornell University Medical

College, 1300 York Avenue, New York, N.Y. Dr. Julius B. Richmond, Department of Pediatrics, Upstate Medical Center,

766 Irving Avenue, Syracuse, N.Y. Dr. Frederick C. Robbins, Department of Pediatrics, Cleveland Metropolitan

General Hospital, 3395 Scranton Road, Cleveland, Ohio. Dr. Edward B. Shaw, Department of Pediatrics, University of California Medi

cal Center, San Francisco, Calif. Dr. Joseph Stokes, Jr., Department of Pediatrics, Children's Hospital, 1740

Bainbridge Street, Philadelphia, Pa. Dr. Richard E. Wolf, Pediatric Psychiatry Clinic, the Children's Hospital, El

land and Bethesda, Cincinnati, Ohio.

Senator KEFAUVER. You have a statement, Dr. Richmond. Will you proceed?

Dr. RICHMOND. Yes, sir.
Mr. WALLACE. Excuse me.

Dr. Richmond, are you representing the views of the Physicians' Council, in addition to your own views?

Dr. RICHMOND. Yes, I am.

I think I should make it clear that I am here primarily as president of that council.

Mr. WALLACE. Dr. Butler, Dr. Goodman, Dr. May, and Dr. Modell are also members of the Physicians' Council?

Dr. RICHMOND. Yes.
Mr. WALLACE. Those who previously testified ?
Dr. RICHMOND. That is quite correct.

Mr. WALLACE. Dr. Dowling will appear tomorrow. He is also a member?

Dr. RICHMOND. Yes, Dr. Dowling is a member.

Senator KEFAUVER. I notice you have a member, Dr. James G. Hughes, of Memphis, Tenn.

Dr. RICHMOND. Yes, sir.
Senator KEFAUVER. He is a very outstanding physician in Tennessee.
Dr. RICHMOND. Yes.

He is one of our active members. I might, since you asked, Mr. Chairman, for further activities, I might indicate that I also am serving on the Council on Mental Health of the American Medical Association as one of my activities.

Senator KEFAUVER. Council on Mental Health?
Dr. RICHMOND. Mental health.
Senator KEFAUVER. How large a council is that?

Dr. RICHMOND. I think it has 8 or 10 members, appointed by the board of trustees of that organization.

Senator KEFAUVER. You are a member of the American Medical Association !

Dr. RICHMOND. Yes, I am.

Senator KEFAUVER. How long have you been on the Council on Mental Health?

Dr. RICHMOND. Approximately 1 year.
Senator KEFAUVER. Who is chairman of that council ?
Dr. RICHMOND. Dr. Leo Bartemeier.
Senator KEFAUVER. Where is he from?
Dr. RICHMOND. Baltimore.
Senator KEFAUVER. All right. Will you proceed?

Dr. RICHMOND. Mr. Chairman and members of the committee, I would like to retiterate that I am appearing here today as the president of the Physicians' Council. I am also professor and chairman of the Department of Pediatrics at the College of Medicine of the State University of New York at Syracuse.

In presenting this statement on S. 1552, as president of the Physicians' Council, it is appropriate that I describe the origins and activities of the council. I do this, not alone for historical purposes, but, rather, because our experiences have considerable relevance for some portions of S. 1552, particularly section 4, part 7, having to do with the transmission of information concerning drugs by manufacturers, packers, or distributors to physicians either directly or indirectly through advertisements or other descriptive matter.

The Physicians' Council is an independent, nonprofit organization of 21 physicians active in medical education and clinical practice who have been attempting to improve the standard of health information disseminated to both the medical profession and the public. Although the council arose out of the efforts of pediatricians who were concerned about the unfortunate effects of the dissemination of improper information on child health and the inappropriate promotion of drugs on the health of children, we soon found there was general concern in this connection with the health of the public generally. Our membership, therefore, has been broadened to include other physicians.

As you know, the American Medical Association discontinued the seal programs of its Council on Drugs and Pharmacy and its Council

The full text of Dr. Richmond's prepared statement may be found on p. 1118. - A list of members and their affiliations is attached as exhibit A.

1

on Foods and Nutrition in February 1955. The award of a seal of approval to drug and nutritional products for display on promotional material and labels had been considered to be an important stimulus to desirable practices of companies with respect to methods of selling their products to the profession and the public. The discontinuance of formal review of material on health (drugs and nutritional products primarily) by independent experts left the field open to companies and advertising agencies and individual editors of medical journals to provide medical review of this material.

A significant social problem with which S. 1552 endeavors to deal soon became apparent to many physicians. A real hazard to the public health resulted from the absence of independent medical judgment in the field of promotion. Some of these hazards are detailed in a publication entitled, “Selling Drugs by 'Educating Physicians, written by one of our members.

This, I think, was entered into the deliberations of this committee recently.

Senator KEFAUVER. I think it is in the record. Who is the author?
Dr. RICHMOND. Dr. Charles May.
Senator KEFAUVER. Yes.
Dr. RICHMOND. Who has appeared.

Senator KEFAUVER. That has been made an exhibit. The page number in the printed record will be inserted.

(The article referred to may be found on p. 948.) Dr. RICHMOND. It is exhibit B in this sequence. Senator KEFAUVER. Yes.

Dr. RICHMOND. This was written by one of our members and reviewed by the members of the council and endorsed by it.

Senator KEFAUVER. It was endorsed by the council ?
Dr. RICHMOND. Yes, indeed.

Clearly, some efforts at correction were called for in the absence of any organized effort to deal with the problem. The problem was sufficiently serious to move some manufacturers of products used in pediatric care to provide moral and financial support to a group of pediatricians similarly concerned to form the National Council on Infant and Child Care in March 1956 (this organization later became the Physicians' Council).

Senator KEFAUVER. Did it become the Physicians' Council when you came to the conclusion that you had to be concerned with drugs, other than those having to do with the health of children?

Dr. RICHMOND. Yes, and because the many inquiries on the part of physicians who are not pediatricians concerning our activities and their interest in participating in our activities.

Senator KEFAUVER. When was the name changed to “Physicians' Council”?

Dr. RICHMOND. I think in 1958, sir. It could have been as late as 1959.

Its stated purpose was “to disseminate information relating to care and treatment of infants and children; to disseminate analyses of material distributed which relates to such care and treatment; and to cooperate with public, private, scientific, or medical groups, associa

1 A copy of this publication is attached as exhibit B.

tions, or corporations in fostering and promoting such care and treatment."

The first activity of the council was the development of codes to set high standards for the preparation of material for dissemination through the mass media, both promotion and educational, whether intended for the profession or the laity. A copy of these codes I would attach as exhibit C of my presentation.

Senator KEFAUVER. This will be exhibit 47 to this hearing.
(Exhibit 47 may be found on p. 861.)
Senator KEFAUVER. All right, sir.

Dr. RICHMOND. A modification of the AMA seal program was devised to offer some form of public recognition to those who adhered to the standards of the codes, by awarding the privilege of display of the insigne of the council on material meeting the standards of the codes. Submission of material for this purpose was entirely voluntary. Our concern was only with the accuracy and appropriateness of information being disseminated.

In addition, for those not wishing to display the council's insigne, a consultative service was provided for informal, confidential review of material being prepared for the mass media. The aim was to be helpful and to improve material as far as possible.

There was no fee for these services and anyone could turn to the physician reviewers of the council for helpful comment without obligation or fear of public criticism-only commendation was to be given publicly where wanted and deserved.

Senator KEFAUVER. By "anyone,” you refer, I take it, particularly to the manufacturers of drugs

Dr. RICHMOND. Yes, although writers for the mass media were also invited to consult us, if they so desired, and often did.

Mr. WALLACE. Doctor, did this include any kind of drug or just prescription drugs? Dr. RICHMOND.

This could have been any kind of drug. Mr. WALLACE. In other words

Dr. RICHMOND. We made ourselves available to all firms who were marketing any kind of medication.

Mr. WALLACE. Like hair oil?

Dr. RICHMOND. Yes, baby oils and baby powders and things of this sort.

Mr. WALLACE. It included everything?
Dr. RICHMOND. Nutritional products, as well, yes.
Senator KEFAUVER. But was your chief concern with ethical drugs?

Dr. RICHMOND. This was one of our chief concerns, sir. I cannot say

that it was the only one. Senator KEFAUVER. All right, sir.

Dr. RICHMOND. This seemingly attractive arrangement was immedately made use of by a number of firms and individuals. All of these reported satisfaction with the service and appreciation for the help that was given. But widespread use would have been required to make a significant impact in solving the problem and to build a significant influence of the council. Some observers among the pharmaceutical manufacturers apparently foresaw a growing influence of the council and perhaps feared a restraining force on unbridled

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promotion, for as soon as this insigne program of the council began to have appreciable acceptance and material bearing the insigne attracted attention, an organization of the principal ethical pharmaceutical manufacturers (medical directors of the American Drug Manufacturers Association, now part of the Pharmaceutical Manufacturers Association) adopted a resolution in February 1958, calling upon its members to avoid cooperation with the Physicians' Council. They indicated that the industry's own principles and its medical directors could assure high standards in promotional material.

Senator KEFAUVER. Just a minute, Dr. Richmond. You say: The medical directors of the American Drug Manufacturers Association, now part of the Pharmaceutical Manufacturers Association, adopted a resolution in April 1958.

Have you a copy or have you seen a copy of this resolution?

Dr. RICHMOND. I have seen a copy, sir. I do not personally have a copy, but I have seen it.

Senator KEFAUVER. Is there some representative of the Pharmaceutical Manufacturers Association present? Is there anybody from the PMA present in the audience!

Mr. CONNERY. Senator, I am from PMA. I am George Connery.

Senator KEFAUVER. Will you supply us with a copy of this resolution?

Mr. CONNERY. If you will tell me what resolution it is you want, I will be glad to.

Senator KEFAUVER. The one referred to on page 4 of Dr. Richmond's statement. I think it was first considered in February 1958.

Mr. CONNERY. I will try to do that.

Senator KEFAUVER. If you will supply that, we will make that exhibit 48.

Mr. WALLACE. Doctor, do you recall any other reasons that were given in the resolution, other than that which you have set out, for refusing to cooperate ?

Dr. RICHMOND. I think the reason is indicated in the sentence I read last. They indicated that the industry's principles and its medical directors could assure high standards in promotional material.

Mr. WALLACE. Do you recall that that is the only reason that was given or were there other factors considered?

Dr. RICHMOND. What is that?
Mr. WALLACE. Were there other factors considered, do you know?

Dr. RICHMOND. To the best of my knowledge, this would be the sum and substance of the reason.

Mr. WALLACE. I think probably, Mr. Chairman, that this resolution, being produced, it probably ought to be inserted in the record at this point because there may be some other stated reasons that should follow this.

Senator KEFAUVER. Very well.

Rather than making it exhibit No. 48, we will make it a part of the record at this point.

(The resolution referred to follows:)

STATEMENT ON REVIEW OF ADVERTISING COPY BY OUTSIDE GROUPS The medical section of the American Drug Manufacturers Association, as has been made clear on numerous occasions, supports the basic objective of the Physicians' Council for Information on Child Health, namely “the maintenance

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