invited to repeat what is already well known they will say. At best, it ensures a tired performance. So often that it cannot be a coincidence, all disputants monotonously express the same point of view. This seems to have been conveniently arranged in advance to prevent feather ruffling, unlike the old-fashioned symposia in which speakers were specifically chosen to invoke dispute as well as discussion. A symposium now also implies a sounding board for the "latest" on new developments which, in the Madison Avenue code, means premature and poorly digested statements, statements which would never pass the editorial referees of a first rate medical journal. It is a device to have unpublishable stuff published. Quality, bias, thoroughness appear to matter little. Enough stuff to fill a monograph seems to be the goal. It has become less easy for me to be trapped by the program director who has very skillfully interwoven the interesting papers with filler so that there is no escape from listening to the junk. My recent opinions are based mainly on attendance forced on me when I found myself inveigled into playing a part in them and on my reading, which is voluntary and substantial. The latter is a far more satisfactory method of sampling than attendance because one can cover more symposia that way (and at home, glory be!). One does not miss a thing either, since, because of unanimous editorial purity on this one point, not a single word uttered at these meetings is ever mislaid. This I can attest to from personal experience. I am not a modest man but even I think they go too far. At one symposium at which I sat on a panel, my sole contribution to the entire proceedings was to respond to a question with "No." I cannot recall the question. Only my answer is now memorable. Not only was this gem published verbatim alongside my name but it apparently was a sufficient contribution to lead to my inclusion with a stretched-out account of my titles and connections in the list of contributors and to the use of my name in ad vertisements for the sale of the symposium in book form. Why are so many symposia so devastatingly boring? Why is not their prime purpose the promulgation of knowledge? Why do they repeat themselves ad nauseum? Why are there so many cursorily collected laboratory and clinical observations reported? Why so much unfinished business? Why are they so full of insubstantial mental meanderings? In this age, when there is much that is both new and difficult, who can afford to waste time on the tripe that is served up at so many symposia? Why are no editorial scissors used before publications? In court records it is essential that every spoken word be taken down (and it is conceded that the verbatim records of even the most exciting murder cases are shatteringly dull), but why is this procedure used for scientific meetings? The scientific editor must function as an editor, not as proofreader for a court stenographer. For me the editor's proper function starts early-in the programming. His objective should be to have a few good speakers and a lot of time for lively provocative discussion and thinking. All this seems so clear to me that it should also be to those involved in arranging symposia. Why has the symposium come to such a pass? It is my opinion that this has happened because symposia are being used for something other than that for which they are eminently suited: the extension of knowledge. A rapidly increasing number of symposia are being held for the sole purpose of drug promotion. All expenses, travel allowances for invited speakers, costs of publication, honoraria, free distribution of the published volume (with royalties to the organizer-editor of the symposium) are frequently footed by pharmaceutical manufacturers. I have been informed quite candidly that this is the cheapest form of prestige obtainable for drug promotion. That is why there is no interest in quality; that is why premature and immature statements are encouraged; that is why they are so one sided; that is why there is so much emphasis on publication and republication of the same drivel. And that is why they are such excruciating bores! Why has this been permitted to happen to such a venerable educational instrument? The surprising truth is that substantial medical societies are often parties to these rigged performances. Even such an ivory-towerish institution as the New York Academy of Sciences is not above it; in fact it seems to have become a regular "scientific" feature. Surely the Council of the Academy realizes that to its list of superb publications some incredibly bad ones have been added as a result of this practice. And if such an institution does this, is it at all surprising that lesser organizations all over the country do likewise? I have no quarrel with honest advertising of drugs-outright advertising. This is the American way, and that it is not inconsistent with the publication of scientific and unbiased information on medical mat ters is proved by the large number of excellent medical journals which accept advertising matter, which literally depend on it for their existence. It is this arrangement which makes it possible for this JOURNAL to operate and hope to continue to operate. But an advertisement should be called an advertisement. An advertisement in a medical journal may not be presented as if it were part of the text. In the same way, a collection of biased promotional speeches for a drug must not be presented as if it were an unbiased educational forum. I take issue with all who are parties to this perversion of an important postgraduate educational instrument into an insidious promotional device. There is the real danger that, should the symposium continue to be degraded by this practice, good symposia will disappear. Perhaps we need a Colloquium on the Symposium. Maybe Madison Avenue will give it back to the Indians. Walter Modell Published by Drug and Therapeutic Information, Inc., 136 East 57th Street, New York 22, New York Vol. 3, No. 8 (Issue #59) April 14, 1961 TESTS OF PENICILLIN G TABLETS Laboratory tests of buffered potassium penicillin G tablets just completed for The Medical Letter show that the samples purchased from every one of the 42 companies included in the survey met U.S. Pharmacopeia XVI requirements for antimicrobial potency and rate of disintegration. The tablets in a few of the samples showed slightly excessive weight variation in terms of USP requirements, but the variation has no clinical significance. None of the samples had excessive moisture content. Penicillin tablets are covered by government certification requirements, which means that the manufacturer must submit a sample of every batch to the Food and Drug Administration for approval prior to the marketing of the batch. The Medical Letter tests indicate that the certification procedures are effective, and that inexpensive penicillin tablets may be safely stocked by pharmacists and prescribed by physicians. (The cost to the pharmacist of the 200,000unit tablets tested ranged from 95¢ to $9.90 per hundred.) In view of the high cost of the "name" brands of penicillin tablets, the potential saving is considerable, especially for rheumatic fever patients and others who must take penicillin tablets prophylactically. USP REQUIREMENTS - Penicillin G tablets are required to contain not less than 85 per cent of the labeled amount of the antibiotic. Bioassay of the samples by the cylinder-plate method showed that all had at least the required amount. The Pharmacopeia sets no upper limit on the potency of the tablets, and a few of the samples contained much more penicillin than is required; the maximum amount found in a "200, 000-unit" sample was 390, 000 units, and in a "250,000-unit" sample, 412,000 units. The negligible toxicity of penicillin is one of the reasons given for the lack of an upper limit; another reason is the belief that variations in potency such as are found in different tablets will not affect the occurrence of hypersensitivity reactions. The least amount of penicillin found in the "200,000-unit" tablets was 184,000 units, and the median was 224,000 units. The minimum amount in the "250,000-unit" tablets was 226, 000 units, with a median of 268,000. DISINTEGRATION - The Pharmacopeia requires that all of 6 tablets, or no fewer than 16 out of 18 tablets, disintegrate completely within one hour in simulated gastric fluid test solution at about 37°C. (body temperature). All samples met this requirement. MANAGING DIRECTOR Arthur Kallet; EDITORIAL BOARD: 13tt 1. Gardner, M.D., Prof. of Pediatrics, State Univ. of NY, Upstate Medical Center; LOSS ON DRYING - The Pharmacopeia limits weight loss on drying under specified conditions to 1 per cent. All of the samples were found to be within proper limits for moisture content when tested by a variation of the USP method. (The variation was considered acceptable by FDA chemists.) WEIGHT VARIATION - The standard requires that not more than two tablets differ by more than 5 per cent from the average weight of 20 tablets in a sample, and that no tablet differ by more than 10 per cent from the average weight. All but three samples met this requirement. In one substandard sample, three tablets deviated from the average weight by more than 5 per cent but less than 10 per cent. Each of two other samples contained one tablet deviating by more than 10 per cent from the average weight (see table). As already pointed out, Medical Letter antibiotics consultants consider these deviations to be without any clinical significance. Technically, however, the samples are substandard, and are so reported. As in previous tests of prescription drugs for conformance to USP requirements, all samples were purchased from the companies by pharmacists in no way identified with The Medical Letter. The bioassays and the physical tests were performed by two different commercial laboratories, both having long experience with such tests. The samples, as sent to the laboratories, were identified only by code number. Most of the samples were 200,000-unit, but some were 250,000-unit. Tablets of both sizes were purchased from a few companies selected at random. The following table shows for each sample the percentage of the labeled The only significant disadvantage of penicillin G as compared with penicillin V or phenethicillin (Syncillin and other brands) is its poorer absorption. If it is taken on an empty stomach to minimize degradation by gastric acids, penicillin G generally provides adequate blood levels, and it has the advantage of being much less expensive than the other oral penicillins. 73753 0-61-pt. 2-34 |