mg. daily to ensure maximum therapeutic response. Maintenance Dosage: When improvement is obtained, the Dosage Regimen in Acute Gouty Arthritis: The treatment of Dosage Regimen in Acute Superficial Thrombophlebitis: In severe forms of a variety of acute local inflammatory con- In selecting the appropriate dosage in any specific case, To minimize gastric upset, Tandearil should always be taken Duration of treatment The action of Tandearil is usually manifest by the third to In the treatment of transient conditions, such as painful Electrolyte balance Tandearil has a definite tendency to produce sodium reten- Gastrointestinal tract Nausea and vomiting are observed more frequently in pa- Although Tandearil has been found to be better tolerated Tandearil sometimes produces a moderate lowering of the drug have occurred. It is, therefore, imperative to guard Allergic response Drug rash occasionally occurs as a complication of Tan- Rarely, a generalized type of allergic response occurs which Tandearil Geigy (for complete Statement of Directions, please see inside) initial: 300 to 600 mg. daily, in divided maintenance: Minimum effective level, 400 mg. immediately, then 100 mg. every 4 hours until articular inflammation subsides, usually within initial: 600 mg. daily in divided maintenance: 300 mg. daily. Usual initial: 400 to 600 mg. daily in divided maintenance: 300 mg. daily. Usual SOCIAL PROCESSES IN PHYSICIANS' ADOPTION OF A NEW DRUG JAMES COLEMAN, CHICAGO, ILL.. HERBERT MENZEL, NEW YORK, N. Y., AND ELIHU Katz, Chicago, ILL.* From the Bureau of Applied Social (Received for publication Sept. 26, VER the past 20 years the practice of medicine has undergone profound changes, not the least of which has been the accelerated rate of change itself. Again and again, new diagnostic techniques, new laboratory tests, new drugs, new forms of anesthesia, new surgical procedures, and new principles of patient management make their appearance. Most of these innovations are minor steps which alter the medical scene only by gradual accretion, if at all; many, indeed, are short-lived or quickly superseded; a few have been milestones in medical developments. Whatever the ultimate significance of a new practice may be, its immediate fate, once it has been launched from the laboratory or research clinic, rests in the hands of the practicing physician in the field. The pathways by which a successful innovation in medical practice spreads through the profession have seldom been systematically investigated. The present study is a contribution toward that end. It concerns the fate of a single innovation in four cities, a new variant in a well-established family of drugs. Such a case study can hardly claim to represent the course of all types of medical innovations under all circumstances, but it does illuminate some important paths This is the first of two articles and may be identified as Publication No. A-273 of the Bureau of Applied Social Research, Columbia University. Preparation was facilitated by funds provided by a grant to the Bureau of Applied Social Research from the Eda K. Loeb Fund. Philip Ennis, Marjorie Fiske, Rolf Meyersohn, and Joseph A. Precker participated in the planning of the study. Helmut Guttenberg and Sydney S. Spivack gave invaluable aid in the statistical analysis and in the collection of data, respectively. *Coleman and Katz have transferred to the Department of Sociology, University of Chicago, since this study was conducted. and processes through which medical innovations can make their way into the practice of physicians. One may add that drugs are peculiarly suitable as tracers of these paths, because they are physical objects with standardized names, their release dates are easily ascertainable, and pharmacists maintain exact prescription records. Fig. 1.-Cumulative proportion of doctors introducing gammanym over a 16-month period (N = 125). The data of this study stem from two sources. In four midwestern communities, interviews were conducted with 125 general practitioners, internists, and pediatricians, who generously contributed an average of 11⁄2 hours of their time. They constituted 85 per cent of all practitioners of their specialties in these cities. In addition, data on the prescriptions written by these 125 physicians were obtained from almost all the pharmacies in these communities.* The prescription data covered a period of 16 months beginning with the release date of a new drug which will here be called "gammanym." At this time two older drugs of the same general type were in widespread use. They had appeared some years earlier and are here designated as "alphanym" and "betanym." The three *Ninety-one additional interviews were held with practitioners of other specialties, but their prescription record was not examined. The communities had altogether 356 physicians in active private practice. The sample was designed to include all the general practitioners, internists, and pediatricians, and a selected group of other specialists. The population of the four cities ranged from about 25,000 to just over 100,000. medications belong to a well-established family of drugs which has widespread applicability in the hands of general practitioners and many specialists. By the end of the survey period, 16 months after its release, gammanym had become at least a part of the standard medication of most practicing physicians; 87 per cent of the general practitioners, internists, and pediatricians in the sample under study had introduced it into their practice. But this change had been neither immediate nor all-encompassing. The over-all rate of introduction of gammanym by these doctors is seen in Fig. 1. This cumulative curve indicates for each stated date the percentage of doctors who had already prescribed the drug up to that time. As can be seen, more and more doctors introduced the drug during this 16-month period until almost 90 per cent had used it; then the curve finally leveled off. Fig. 2.-Overlapping use of alphanym, betanym, and gammanym during three time intervals. To be sure, the rapid rise in the use of gammanym did not mean that its predecessors, alphanym and betanym, were dropped from use. The degree of overlapping use of two or three of the drugs by the same doctor is pictorially represented in Fig. 2, for three time intervals, representing the beginning, middle, and end of the period studied. Thus, for example, as late as 16 and 17 months after the release of gammanym,* only 22 per cent of the doctors were prescribing gammanym exclusively, while 15 per cent were prescribing both betanym and gammanym, 13 per cent were prescribing both alphanym and gammanym, and 20 per cent were writing prescriptions for all three drugs during these same 2 months (more accurately, during the 6 sampling days representing these 2 months). The introduction of gammanym meant for most doctors an addition to whatever drugs of this type they were already using, rather than a substitution. Only slowly, if at all, did some of the doctors stop using the older drugs. DRUG ADOPTION AND INDIVIDUAL CHARACTERISTICS OF PHYSICIANS This, then, describes the over-all course of the acceptance of gammanym in these four communities, from the time it first arrived on the drugstore shelves *The prescription data were 3-day samples at intervals averaging 28 1⁄2 days, which are here termed "months," so that the 16-month survey period contains 17 such "months." Because of the nature of time sampling, the introduction dates recorded here may be somewhat later than the physicians' actual introduction of the drug. |