Chapter 51

THE PATENT-MEDICINE EVIL

"Dhrugs," says Dock O'Leary, "are a little iv a pizen that a little more iv wud kill ye. Ye can't stop people fr'm takin' dhrugs, an' ye might as well give thim somethin' that will look important enough to be inthrojuced to their important and fatal cold in th' head. If ye don't, they'll leap f'r th' patent medicines. Mind ye, I haven't got annything to say agin' patent medicines. If a man wud rather take them thin dhrink at a bar or go down to Hop Lung's f'r a long dhraw, he's within his rights. Manny a man have I known who was a victim iv th' tortures iv a cigareet cough who is now livin' comfortable an' happy as an opeem fiend be takin' Dr. Wheezo's Consumption Cure." The Dock says th' more he practices medicine th' more he becomes a janitor with a knowledge iv cookin'. He says if people wud on'y call him in befure they got sick he'd abolish ivry disease in th' ward except old age and pollyticks.

Thus Mr. Dooley with his usual wit and insight tells the American people why they spend over two hundred million dollars annually on patent medicines. Americans consume more drugs and use more patent medicines than the people of any other country on the civilized globe. Self-medication has grown to tremendous proportions. Everywhere--in cars, on transfers, on billboards, in magazines, in newspapers, in the mails--are advertised medicines to cure disease and devices to promote health. When we consider that electric cars contain from thirty-two to fifty-two advertisements each, three fourths of which are directly or indirectly concerned with health; when we multiply these by the number of cars actually in use in American cities; when we consider the number of advertisements in magazines and daily papers, and the enormous circulation of these papers and magazines; when we consider that an increasingly large proportion of advertising space is devoted to health,--we begin to realize the cumulative power for good or for evil that health advertisements must have.

To illustrate advertisements devoted to health to-day, I have kept clippings for one week of news items, editorials, and advertisements in a penny and a three-cent paper, and had them classified according to the subjects treated:

===================+=========================+======================== | PENNY PAPER | THREE-CENT PAPER +------+---------+--------+-----+---------+-------- | News |Editorial| Adver- | News|Editorial| Adver- | Item | |tisement| Item| |tisement -------------------+------+---------+--------+-----+---------+-------- Milk | 3 | -- | 2 | 3 | -- | 2 Teeth | -- | 1 | 2 | -- | -- | 1 Shoes | -- | -- | 4 | -- | -- | 1 Food | 1 | -- | -- | 1 | -- | 4 Alcohol | 1 | -- | 5 | 3 | -- | 7 Tuberculosis | -- | -- | 1 | 1 | -- | -- Patent medicine | -- | -- | 17 | -- | -- | -- Constipation cures | -- | -- | 4 | -- | -- | 5 Eyes | 3 | -- | 5 | 1 | -- | -- Beauty | 2 | 5 | 8 | -- | -- | 6 General | 8 | 3 | 3 | 5 | -- | -- -------------------+------+---------+--------+-----+---------+-------- Total | 18 | 9 | 51 | 14 | -- | 26 ===================+======+=========+========+=====+=========+========

The following list of health topics was treated in the advertisements, editorials, and articles of a popular monthly periodical devoted to women:

=========================+=========+===========+=============== | ARTICLE | EDITORIAL | ADVERTISEMENT -------------------------+---------+-----------+--------------- Babies | 1 | -- | 11 Soaps and powders | -- | -- | 5 Beauty | 3 | -- | 6 Quack cures | -- | 2 | -- Tooth powders | -- | -- | 4 Household | 1 | -- | 5 Food and cooking | 1 | -- | 14 Clothes | 13 | -- | 5 Teaching sex laws | 1 | 2 | -- Medicine | 4 | 1 | -- -------------------------+---------+-----------+--------------- Total | 24 | 5 | 50 =========================+=========+===========+===============

Besides the classic patent medicines, such as Lydia Pinkham's Vegetable Compound, Castoria, Cod Liver Oil, etc., there are "Colds Cured in One Day," "Appendixine," health foods, massage vibrators, violet rays, Porosknit underwear, sanitary tooth washes, soaps, vitopathic, naturopathic, and faith cures. New ones appear every day,--enough to make a really sick person dizzy, let alone a person suffering from imaginary ailments. All seem to outline my particular symptoms. After they have flamed at me in red letters in the surface cars, pursued me in the elevated and underground, accompanied me out into the country and back again to the city, greeted me each morning in the daily paper and in my daily mail, each week or each month in the periodical, the coincidence of a familiar package on a drug-store counter seems to be providential and therefore irresistible. I know that I ought to be examined by a physician, but I am busy and not unwilling to gamble for my health; it cannot kill me and there is a chance that it will cure me. If there is nothing the matter with us, we may be cured by our faith. If we are taking a cure for consumption, the morphine in it may lull us into thinking we feel better. If we are taking a tonic for spring fever, the cheap alcohol may excite us into thinking our vitality has been heightened. Soothing sirup soothes the baby, often doping its spirit for life, or soothing it into a sleep from which it never wakes.

In spite of the fact that the "Great American Fraud" has been exposed repeatedly in newspapers and magazines of wide circulation, the appeal of the quack still catches men and women of intelligence. The other night a friend went out to a dinner and conference with a lawyer in the employ of the national government. Annoyed by a nagging headache, he made for the nearest drug store and ordered a "headache powder." He admitted that it was an awful dose, but he had been told that it always "did the business." He knew the principle was bad, confessed to a scorn for friends of his whom he knew to be bromo-seltzer fiends, but he had the headache and the work to do--a sure cure and a quick one seemed imperative. The headache was due to overwork, indigestion, constipation. Plain food and quiet sleep was what he needed most. But the dinner conference plus the headache was the unanswerable argument for a dose with an immediate result.

Last winter an Irish maid slowly lost her rosy cheeks and grew hollow-eyed and thin. She was taken to a specialist who discovered a rapidly advancing case of consumption. He said that owing to the girl's ignorance, stupidity, and homesickness, her only chance of recovery was to return to the "auld countrie" at once. The girl agreed to go, but insisted on a few days "to talk it over with her cousins in New York." After two weeks had elapsed she was found in a stuffy, overcrowded New York tenement. She had found a doctor who had given her a little bottle of medicine for two dollars, which would cure her in the city. It was futile to protest. Days in the unventilated tenement and nights in a "dark room" meant that she would never live to finish the bottle.

For a year Miss H. took a patent preparation for chronic catarrh. It seemed to "set her up"; but it so undermined her strength, through its artificial nerve spur, that chronic catarrh was followed by consumption. It later transpired that the cure's chief ingredient was whisky, and cheap whisky. A good grandmother, herself a vigorous temperance agitator and teetotaler, offered to pay for it as long as my friend would take it faithfully. The irony of it makes one wonder how many earnest advocates of total abstinence are in reality addicted to the liquor habit.

Last summer a district nurse of the summer corps who visited city babies under two years of age encountered in the hallway of a tenement a bevy of frenzied women. A baby lay on the bed gasping and "rolling its eyes up into the top of its head." The nurse asked the frightened mother what she had been giving it. "Nothing at all," said the woman. But a telltale bottle of soothing sirup showed that the child was dying from morphine poisoning. Happily the nurse came in time to save it.

Is it not pitiful, this grasping for a poison in an extremity; this seizing of a defective rope to escape the fire?

The patent-medicine evil cannot be cured by occasional exposure or by overexposure. Nor can it be cured by legislation, legislation, legislation, unless laws are rigidly enforced.

Occasional exposure is no better than occasional advertising of good things. The patent-medicine business thrives on constant, not occasional, advertising. Leading advertisers expect so little from the first notice that they would not take the trouble to write out a single advertisement. That is the reason merchants charge advertising in the programmes of church, festival, and glee-club concert to charity, not to business. Warning people once does no more lasting good than sending a child to school once a month. The exposure of patent-medicine evils must be as constant as efforts to sell the medicines.

Overexposure is ineffective. It is the evils of patent medicines that do harm, not their name and not their patents. The medical profession has in vain protested against proprietary medicines. Ethical barriers cannot be erected by resolution. Calling things unethical does not make them unethical. The mere patenting of medicines for profit does not make the medicine injurious any more than the mere mixing of unpatented drugs makes a physician safe. Physicians who would not themselves patent a drug will use certain patented drugs whose ingredients are known to be safe and uniform. True exposure of patent-medicine evils will enable the average physician and the average layman to distinguish the dangerous from the safe, the fraud from the genuine, lies from truths.

Legislation is needed to crystallize modern knowledge and to establish in courts the right to protection against the evils of patent medicines. The national Pure Food Law, passed January 1, 1907, and now in force throughout the country, requires on the "labels of all proprietary medicines entering into interstate commerce, a statement of the quantity or proportion of any alcohol, morphine, opium, heroin, chloroform, cannabis indica, chloral hydrate, or acetanilid, or any derivative or preparation of any such substance contained therein; this information must be in type not smaller than eight-point capital letters; also _the label shall embody no statement which shall be false or misleading in any particular_." This law does not forbid patent medicines nor the use of alcohol and narcotics in patent medicines; it merely says, "Let the label tell, that all who _buy_ may read." It does not require that all who _run_ may read, for _it does not say that advertisements of a patent medicine shall tell the truth about its ingredients or its action on the human body_; only that the label on the bottle shall tell. The object of this law is to explain to the consumer the exact nature of the medicine. But to the majority of people the word "acetphenitidin" on the label of a headache medicine does not explain. The new order that requires manufacturers to substitute acetanilid for acetphenitidin does no more than replace fog with mist. Protection requires legislation that cannot be evaded by technical terms. The present law requires that packages must be properly labeled _on entering the state_. To carry out the national law, state laws should make it an offense for dealers to have in their possession proprietary medicines without explanatory labels that explain. Where state laws to this effect do not exist, the packages once in the state may be deprived of their labels and sold as secret remedies, thus nullifying the whole effect of the national law.

Enforcement must be insured. Impure drugs may do as much harm as patent medicines containing harmful drugs. In New York a vigorous campaign was recently inaugurated by the department of health to drive out impure drugs. Drugs are dangerous enough at their best. When they are not what they pretend to be, whether patented or not, they may take life. One extreme case where a patient's heart was weakened when it ought to have been strengthened, led to the discovery that practically all of one particular drug offered for sale in New York City was unfit to use and calculated to kill in the emergency where alone it would be used. Yesterday four lives and several million dollars were lost in a New York fire because the hose was rotten or weak. As inspection and testing were needed to insure hose equal to emergency pressure, so inspection and testing of patent medicines and drugs are needed to make legislation effectual.

Legislation and enforcement should reach the newspaper, magazine, billboard, street car, that advertises a falsehood or less than the essential truth regarding drugs, foods, and patent medicines. Public sentiment condemns the advertising of many opportunities to commit crime or to be disorderly or indecent or to injure one's neighbor. The facts about hundreds of nostrums can be absolutely determined. The advertising agency, whether secular or religious, that carries misrepresentation of drugs and foods should be forbidden circulation through the mails. The existence of such advertisements should be made evidence of complicity in a public offense and punished accordingly. Treat them as we treated the Louisiana lottery. Boards of health, instead of furnishing names to druggists and manufacturers who want to sell patent foods and medicines, should print circulars exposing frauds, and punish so far as the law permits.

While trying to secure adequate legislation and efficient administration of the above-mentioned standards, there is much that can be done by individuals and clubs. We can give preference to those journals that refuse drug and food advertisements unless evidence is produced that the truth is told and that the goods are not harmful. We can refuse to have in the house a paper or journal which prints notices that lie or that conceal the truth. If this drastic measure would cut us off entirely from daily papers, we could choose the least offensive and petition it to exclude specific lying methods. When it preaches health, honesty, and philanthropy, we can cut out of one issue the noble editorial and the exploiting advertisements and send them to the editor with our protest. Knowledge of the ingredients and dangers of patent medicines should be a prerequisite for the practice of medicine or pharmacy. We can help bring about such conditions, and we can patronize physicians who send patients to drug stores that cater to intelligence rather than to ignorance.

Fighting patent-medicine evils is a civic duty to be accomplished by civic coöperation, not private effort. It is impossible to organize unofficial educational agencies that can offset the cumulative, lying advertisement. Personal opposition is but the beginning. Official machinery must be set running and kept running so as to protect the public health against the commercial motive that preys upon ignorance and easily inspired faith.