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90   `What Can Be Done To Protect
      You from Your Doctor?'
      The Capital Times   Tuesday, March 26, 1968

     "The problem is `what can be done to protect you from your 
doctors'" is a quotation attributed to Dr. James L. Goddard,Commissioner
of the Food and Drug Administration, according to a UPI dispatch
from a Senate Committee hearing February 29th.  The pharmaceutical 
industry has become accustomed to the baiting implied by remarks like
these, but the medical profession is a more powerful constituency, and
reacts more vehemently to such aspersions.  The problem is, did Dr.
Goddard cast them?

     Dr. Goddard's testimony before Senator Gaylord Nelson's committee
is now available from the official record.  It is indeed unfortunate
that this will not receive the publicity accorded to this one 
paraphrased sentence, for it is a thoughtful analysis of the problem of
reasonable regulation in an area where the individual physician must
retain the special confidence of his patient: each case of illness is
unique, and it would be impossible to legislate conclusive rules for
the use of a potentially life-saving drug.

     His actual language, in context, is available from the official
transcript.  It follows a dialogue in which Benjamin Gordon of the
Senate subcommittee staff was pressing Dr. Goddard about controlling
the distribution of chloramphenicol.  This is a valuable antibiotic
for certain specific diseases, but has been found to have dangerous
side effects.  Too little is known about these, but between ten and
100 patients per million who received chlorampenicol have suffered
from a serious, often fatal form of drug-induced anemia.  This hazard
has been widely discussed for the past fifteen years.  Nevertheless,
it is assumed that many physicians have imprudently prescribed it,
judging from a much larger market in chloramphenicol than could have
any reasonable medical justification.

     Dr. Goddard remarked: 
     "Well, I would like to ask you, Mr. Gordon, what it is you 
propose be done .  I am at my wits' end as to what can be done within 
the authority and the philosophy of what FDA is supposed to be doing?"

     Gordon:  "I know you do not have the authority.  But... we are
not in a very good shape."
     Dr. Goddard:  "What you are talking about basically is what 
protection do you have from your doctor.  Now, I do not think you can
legislate that.  In the long run, I do not think you can regulate 
good practice of medicine."
     
     Sen. Nelson:  "I do not think anybody is suggesting that really."
     The transcript should give a reassurance to the medical profession
that was lacking from hasty news report.  Its sacred cows, are 
not going to be tethered quite so peremptorily either by senators or
by government officials.  There is, furthermore, another lesson here
in political rhetoric: never comment thoughtfully about a proposal. 
advocate, evade or denounce; there is no middle way.  Frank talk about
"wits' end" or "brainwashed" is also dangerous, but perhaps only if
you are running for the presidency.

     The facts cited in Dr. Goddard's testimony have raised a question,
whether he cares to pursue it or not.  The FDA's meticulous requirements
about advertising have become contraproductive, when every 
incidental report of side effects of a widely used drug must be added to
the fine print.  The self - education or physicians is the only way a
patient can be protected from them, and the system itself is inherently
unsound when many doctors get most of their information about new
drugs form profit - oriented salesmen.  It will not be improved if the
nation stresses number and neglects quality in medical education.

     In the long run, the medical profession itself must tune up its 
rusty machinery of self - discipline if we are to avoid a stifling
overlay of government regulation.

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