Fig. 10b

in anti-inflammatory potency

DECADRON "possesses greater anti-inflammatory potency
per milligram than any steroid yet produced," and is
"the most potent steroid thus far synthesized."2 Milligram for
milligram, it is, on the average, 5 times more potent than
6-methylprednisolone or triamcinolone; 7 times more
potent than prednisone; 28 times more potent than
hydrocortisone; and 35 times more potent than cortisone.

a new in dosage reduction

order of magnitude

References:

1. Boland, E. W: California Med. 18:417 (June) 1958, 2. Bunim, J. J., et al.: Arthr. & Pheum. 1:313 (Aug.) 1958 3. Boland. E. W., and Headley, N. E. Paper read before the Am. Rheum Assoc. June 21, 1958, San Francisco, Calif. 4. Bunim, J. J., et al.: Paper read before the Am. Rheum. Assoc. June 21, 1958, San Francisco, Calif. Copies of papers available An request

Thanks to this unprecedented potency, DECADRON is
"highly effective in suppressing the manifestations of
rheumatoid arthritis when administered in remarkably small
daily milligram doses." In a number of cases, doses as
low as 0.5-0.8 mg. proved sufficient for daily maintenance.
The average maintenance dosage in rheumatoid arthritis
is about 1.5 mg. daily.

in elimination and reduction of side effects
Virtual absence of diabetogenic activity, edema, sodium or
water retention, hypertension, or psychic reactions has been
noted with DECADRON.1,2,3,4 Other "classical" reactions
were less frequent and less severe. DECADRON showed no
increase in ulcerogenic potential, and digestive complaints were
rare. Nor have there been any new or "peculiar" side effects,
such as muscle wasting, leg cramps, weakness, depression,
anorexia, weight loss, headache, dizziness, tachycardia, or
erythema. Thus DECADRON introduces a new order of
magnitude in safety, unprecedented in corticosteroid therapy.

in therapeutic effectiveness

With DECADRON, investigators note "a decided intensification
of the anti-inflammatory activity" and antirheumatic potency.
Clinically, this was manifested by a higher degree of improvement
in many patients previously treated with prednisteroids,3
and by achievement of satisfactory control in an impressive
number of recalcitrant cases.","

in therapeutic range

More patients can be treated more effectively with DECADRON.
Its higher anti-inflammatory potency frequently brings
relief to cases resistant to other steroids. Virtual freedom
from diabetogenic effect in therapeutic dosage permits
treatment of many diabetics without an increase in insulin
requirements. Absence of hypertension and of sodium and
fluid retention allows effective therapy of many patients
with cardiovascular disorders. Reduction in the incidence and
severity of many side effects extends the benefits of
therapy to numerous patients who could not tolerate other
steroids. And a healthy sense of well-being, reported by nearly
all patients on DECADRON, assures greater patient cooperation.

Antipyretic

If Liquiprin (a preparation of salicylamide) could truly be considered "safer than aspirin" (and also as effective as an analgesic and antipyretic), a physician would probably feel obliged to recommend this remedy to his patients. But if he searched for the available information, he would surely be anased to discover that the evidence on toxicity of salicylamides such as Liquiprin is almost entirely from experiments with lower animals, and that only one inconclusive clinical trial was published after this product was placed on the market.

Salicylamides have been known to pharmacologists for about 100 years--the "newness" of Liquiprin seems to be the production of a salicylamide in a liquid suspension.

Johnson & Johnson's advertisement and an elaborate brochure (prepared by L. W. Frohlich advertising agency) have hailed the introduction of the Liquiprin brand of salicylamide with charts portraying "proof" that it was safer than aspirin and assertions of "intensive clinical testing" before launching what has unquestionably been an intensive promotion of the product.

These claims seem exaggerated, to say the least, when compared to the conclusions of Dr. A. K. Done (Pediatrics, 23:774, 1959) after an analysis of the animal toxicity studies: "...when salicylamide and aspirin are compared in

the same laboratory under identical conditions, there appear to be no consistent or striking differences in their toxicities in experimental animals." It seems to be a question of whether man is like a mouse or a rat.

The initial promotional material for Liquiprin (Fig. 12) contained no reference to a clinical trial, simply because no clinical studies of this preparation had been published. Not until after a year of promotion did the only available clinical study of Liquiprin make its appearance (Vignec, A.J., and Gasparick, M.: J.A.M.A., 167:1821, 1958). The authors concluded from their quite limited study that ". "...it is obvious...there would be little to choose between salicylamide and aspirin" as far as antipyretic effects are concerned. The study provided no significant information on the toxicity of either antipyretic, as all but a few of the patients received no more than three doses of the drugs.

With lamentable disregard for precision, for more than 2 years the promotional material for Liquiprin has leaned on reference to this single, limited study to proclaim its effectiveness and safety (Fig. 13). The later claims were that "Liquiprin has been tested in several of the country's leading pediatric hospitals" and that it has "proved well tolerated for continued use--no adverse reactions or evidence of sensitivity have been observed in studies involving many hundreds of children." (Apparently unpublished).

Fig. 12

New

liquid pediatric analgesic-antipyretic

Liquiprin

for children

safer than aspirin, easier to use

for infants' and children's fever, discomfort of colds, minor aches and pains and following immunizations. LIQUIPRIN is a suspension of salicylamide-chemically and pharmacologically distinctive from aspirin and other salicylates. Clinically, its analgesic-antipyretic action is approximately the same as that of aspirin, but its therapeutic action does not depend on conversion to salicylate, salicylic acid or their metabolites. LIQUIPRIN offers these major advantages:

1. Salicylamide is well known for its low toxicity index,16 and the fact that it shows little tendency to sensitization.

2. LIQUIPRIN Salicylamide Suspension is supplied in exclusive non-spill safety bottles from which even the most ingenious youngster cannot pour or drink. The medication can only be obtained by using the non-breakable calibrated dropper.

EASY TO USE:

The convenient liquid form permits the required dose to be easily obtained and accurately measured.
Children love the pleasant taste - there are no administration problems-even in the home.
Blends readily with formula or orange juice.

CLINICALLY EFFECTIVE:

LIQUIPRIN Salicylamide Suspension has been widely tested in several of the country's
leading pediatric hospitals and has been found to provide prompt, effective antipyretic effect-
especially notable in those cases which do not require specific antibiotic therapy."
Proved well tolerated for continued use in studies involving many hundreds of children.7
LIQUIPRIN Salicylamide Suspension contains I gr. salicylamide per cc. It may

be obtained by mothers, at your direction, without prescription.

Recommended dosage: 1⁄2 dropper for each year of age, not to exceed

2 droppers (5 gr.). Each 1⁄2 dropper contains 14 gr salicylamide.

Johnson & Johnson

Liquiprin

for children

cutsapp

References: (1) Bavin, E. M: Macrae, F J: Seymour, D. F, and Waterhouse, P. D. J Pharm & Pharmacol 4 872, 1952 (2) Hart, E R J. Pharmacol & Exper Therap 89 205, 1947. (3) Way, EL, and others. ibid. 168 450, 1953, (4) Feeney G C Carlo, P E., and Smith, P. K. ibid. 174 299, 1955 (5) Ichniowski, CT, and Hueper, W C J Am Pharm A (Scient Ed) 35 225, 1946

(6) Personal communication, Johnson & Johnson Research Foundation, Oct 2, 1956 (7) Vigne, AJ JAMA 167.1821 (Aug 9) 1958 Trademark for salicylamide suspension, Johnson & Johnson.