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 of high standards in promotion of products." It also endorses many of the specific points enumerated in the code for advertising published by the Physicians' Council for Information on Child Health. It is the feeling of the medical section, however, that this objective can not be best achieved by the organization of self-appointed groups in the various medical specialties to review advertising prior to its publication, since this would result in a multiplicity of clearance agencies, responsible only to themselves, which would create confusion and disrupt the normal, prompt and effective process of ethical drug promotion. It is believed that review of advertising by such agencies would be impractical, time consuming, and in many instances, arbitrary since it would be improbable that any individual reviewing authority could be an expert on each of the products on which he would pass. The medical section of the ADMA believes that the objective of maintaining high standards in promotion may best be achieved by each company having on its staff competent medical personnel of high ethical standards to review its promotional material and by vesting in them the responsibility and authority for seeing that all promotional material be accurate and of high informative value. Such a mechanism exists within most, if not all, of the member companies of the ADMA. The best interests of the public, the medical profession, and the pharmaceutical industry will be served by continuing and, where necessary, strengthening the present system of internal control rather than by setting up outside agencies which might have less responsibility and no greater qualifications. Therefore, it is recommended by the medical section of the ADMA that bodies such as the Physicians' Council for Information on Child Health not be encouraged in its procedure for review of advertising material but rather that its laudable objectives should be achieved through the mechanisms of control which already exists within each member firm. Senator KEFAUVER. Mr. Connery, it would be well if we could get the resolution today. Would you call the office and see if they can supply it while we are having this hearing today? Mr. CONNERY. That one resolution? Senator KEFAUVER. Yes. Mr. CONNERY. Surely. Senator KEFAUVER. If we could have it before we recess today, we might want to ask Dr. Richmond further about it. But this is the crux of the reason, as you remember it? Dr. RICHMOND. Yes, sir. Senator KEFAUVER. All right, sir. Dr. RICHMOND. The concern of the members of the physicians' council was sufficiently serious about the misleading aspects of promotional material for us to make every effort to communicate this concern to executives of the firms constituting the Pharmaceutical Manufacturers Association. Accordingly, some of the members of our organization made personal visits to the executives of a number of large pharmaceutical manufacturing concerns. Senator KEFAUVER. You mean some of your 21 members did make visits to some of the drug officials? Dr. RICHMOND. Yes. Some of the members of our organization personally called on the executives, in some instances presidents, other instances vice presidents or medical directors, of some of the large firms that were members of the Pharmaceutical Manufacturers Association. Senator KEFAUVER. Did you call on any of them? Dr. RICHMOND. No, I did not personally. Senator KEFAUVER. All right, sir. Dr. RICHMOND. Also, in January 1959, the Physicians' Council held an all-day conference with a large group of representatives of the major pharmaceutical companies and their advertising agencies to review the objectives and program of the council. It was apparent that more extensive cooperation with the original program was not forthcoming, nor were any alternative plans suggested by representatives of the industry to allow a reasonable influence of independent physicians on the quality of medical information being disseminated through the mass media. I might emphasize that we specifically asked for alternatives to our program, other ways by which the influence of an independent group of physicians could be felt, and no alternatives were forthcoming. Senator KEFAUVER. Where was that meeting held in January 1959? Dr. RICHMOND. At the building of the New York Academy of Sciences in New York City. Senator KEFAUVER. Were most of the large pharmaceutical houses represented? Dr. RICHMOND. Yes, I would say so. Senator KEFAUVER. And the idea was to see what could be accomplished? Dr. RICHMOND. Yes, sir. Senator KEFAUVER. What were you trying to accomplish at this meeting? Dr. RICHMOND. What we were trying to accomplish, sir, was to communicate the objectives of our program on the possibility that perhaps our efforts were being misunderstood, but, just as significantly, we were trying to gain from the manufacturers and their public relations firms suggestions concerning alternative ways of dealing with the problem. Senator KEFAUVER. That is, if they did not like your present program, what program would be acceptable? Dr. RICHMOND. Yes, sir. Senator KEFAUVER. Which advertising firms were they, do you recall? Dr. RICHMOND. I do not have a list of them, sir, but I can readily get it and make it available to the committee. I do not happen to have it with me. Senator KEFAUVER. Do you have a list of the people present? Senator KEFAUVER. We will make that part of the record. If you will give us a list of who they are, what companies they represent, what advertising public relations firms. I think that might be useful. Dr. RICHMOND. Yes, sir, we will be glad to do that. Senator KEFAUVER. When you say "disseminated through the mass media," what do you mean by "mass media"? Dr. RICHMOND. We were thinking of the press, the magazines, the radio, television, all of these media. Senator KEFAUVER. It would be particularly proprietary drugs or supplies that would be talked about over the radio and newspapers? Dr. RICHMOND. Yes, sir. Senator KEFAUVER. And ethical drugs in the medical journals? We were dealing with both at that time and we were concerned about both. Senator KEFAUVER. Concerned about details, what detail men and women said, also? Dr. RICHMOND. Yes, sir. Senator KEFAUVER. All right, sir. So the meeting came to nothing, is that what you mean? Dr. RICHMOND. Yes, sir. It became apparent to us that we were going to receive no cooperation for our program, at any rate, from industry and from the advertising agencies. Mr. WALLACE. Doctor, you do receive financial assistance from these drug manufacturers today, do you not? Dr. RICHMOND. Our last grant was made in 1960. Mr. WALLACE. I think that yesterday's witness testified that about 85 percent of the moneys supporting the Physicians' Council came from drug manufacturers. Dr. RICHMOND. Yes, that is quite right, but the last grant we had was in 1960. Senator KEFAUVER. The last grant was from whom? Dr. RICHMOND. That was from the Ross Laboratories. Senator KEFAUVER. Ross? Dr. RICHMOND. Laboratories, at Columbus, Ohio. Senator KEFAUVER. That is one of the smaller companies, it is not? Dr. RICHMOND. Yes. Mr. WALLACE. Do you expect to receive financial assistance in 1961? Dr. RICHMOND. I have some doubts. Mr. WALLACE. What other purposes does the Physicians' Council have? What other objectives does the Physicians' Council have? Dr. RICHMOND. This is our only objective, to improve communications concerning that is, improved standards for information that is communicated both to the profession and to the public. Mr. WALLACE. So you have been operating in that field. You have been doing actually that, have you not, even though the seal program has been discontinued? Dr. RICHMOND. Well, I will come to what our program is. Mr. WALLACE. I will not interrupt further. Dr. RICHMOND. We have discontinued the seal program. Dr. RICHMOND. The general assumption of the industry appeared to be that physicians should be able to protect their own interests and the interests of the public could be left to such agencies as the Food and Drug Administration and the Federal Trade Commission. It was also argued that the medical directors of the pharmaceutical firms could provide adequate medical supervision of promotional material. Privately, medical directors have indicated that their judgments are frequently disregarded in the development and dissemination of promotional material. By the spring of 1959, it became evident that the council must find better means of reaching a position of influence and effectiveness. It was decided to discontinue the insigne program and the consultative service on promotional educational material, and to devote the resources and energies of the council to other approaches to its objectives. As the council was made up of medical educators it seemed natural to redirect efforts at reaching the educators and through them to create an awareness of the problems and a determination to increase professional influence in matters of health education. It did not seem to the Physicians' Council that educators are adequately concerned about the drift of influence over the habits and beliefs of physicians into the hands of promoters of drugs and health products. Accordingly, a study was conceived to gain objective evidence of the relative impact of the traditional sources of medical education (medical schools and societies) compared to the effect of promotional campaigns of industry, as far as current information and practices of physicians are concerned. Arrangements have been made to conduct such a study under joint sponsorship of the Physicians' Council and the Bureau of Applied Social Research of Columbia University. A preliminary study is now underway and a grant application to extend it has been submitted to the National Institutes of Health. Senator KEFAUVER. I want to say here that the National Institutes of Health are serving a very fine purpose and receiving enthusiastic support from the Congress and from the administration. I certainly hope the National Institutes of Health will approve this program. Dr. RICHMOND. Thank you very much, sir. We anticipate that it will be reviewed routinely, as all research grants are reviewed, and I think in a very fair and admirable fashion. We have been concerned, as medical educators, with the vast resources available for promotion by the pharmaceutical industry in contrast to those available to the medical schools. It is estimated that the expenditure for promotion is nearly four times that for the medical schools annually. Senator KEFAUVER. You mean the cost of running the medical schools? Dr. RICHMOND. Yes. Senator KEFAUVER. It runs about $200 million a year? Dr. RICHMOND. That is correct, sir; in contrast to the $750 million available for promotion. Mr. WALLACE. Doctor, could you not also add after the word "promotion" the words "and education"? Do you mean to tell us that the pharmaceutical industry is all promotion and no education? Dr. RICHMOND. I think the members of the Physicians' Council would feel that there should be a clarification of these roles, and we, I think, take the position that education should be in the hands of educators and not in the hands of advertising agencies. Mr. WALLACE. What do you mean by "promotion"? In using the word "promotion" there, what are you saying? Dr. RICHMOND. Advertising. Mr. WALLACE. All advertising? You would include detail men's salaries? Dr. RICHMOND. Yes, indeed. Mr. WALLACE. You do not consider them to be people who are educating the physician? Dr. RICHMOND. No; I do not. And I do not think any of the members of the Physicians' Council feel that way. Mr. WALLACE. In other words, you take the position that all this money spent by the manufacturers of drugs is for promotion and none for education? |