The British Pharmacological Society's WDM Paton Memorial Lecture 2019: How doctors were informed about pharmaceutical products through advertising in the British Medical Journal from 1955/6 to 1985/6.

We have reviewed pharmaceutical advertisements in every available issue of the British Medical Journal (BMJ) in 12-month periods during 1955/6, 1965/6, 1975/6, and 1985/6. We have determined the amount of advertising, the therapeutic areas covered, and whether adverts reflected the large number of New Chemical Entities (NCEs) launched during that time. For each product we recorded the therapeutic indications, the marketing company, and the number of adverts appearing. The total number of products advertised fell from 340 in 1955/6 to 260 in 1965/6, 70 in 1975/6, and 16 in 1985/6. Advertisement numbers and companies advertising also fell. Antimicrobial drugs and cardiovascular drugs were the top products advertised over the 30 years, with respiratory, analgesic, and gastrointestinal drugs also in the top five. The number of different drugs advertised by individual companies fell from around eight per company in 1955/6 to one or two in 1985/6. There was good concordance between the most advertised therapeutic areas and NCEs entering the market. From the 1950s to the 1980s prescribers were extensively informed about pharmacological advances in therapeutics through BMJ advertisements. Many novel drugs that were advertised proved to be of lasting value. The Medicines Act 1968 introduced product licensing, regulations requiring demonstration of quality, efficacy, and safety, and restrictions on advertising. Subsequently many companies reduced their advertising or stopped altogether. Since advertising influences prescribing, and since antimicrobial drugs were the most commonly advertised products during 1955-86, we speculate that advertising, resulting in excess use, may have, at least partly, driven bacterial drug resistance.

Healing Animals in an Antibiotic Age: Veterinary Drugs and the Professionalism Crisis, 1945-1970.

Between 1945 and 1970, the introduction of antibiotics in agriculture forced veterinarians to articulate the boundaries of their professional identity. While veterinarians welcomed the new aid to arrest infectious diseases of livestock, they worried as farmers took animal healing into their own hands without veterinary supervision, and resented the competition from retail outlets that sold the drugs. Veterinary antibiotics also set off heated debates within the field about whether the profession should position itself as preventers or healers of disease, debates that were akin to the kinds of professional discourses among physicians and pharmacists in the same period. By calling attention to the social context that helped facilitate an increasing reliance on the veterinary antibiotics, this article helps explain the sources of present-day overuse of such antibiotics in American agriculture.

Regulations with plenty of loopholes--the doctors' prescription rights during the era of prohibition 1916-1926.

BACKGROUND: In Norway, the sale of distilled spirits was prohibited from 1916 to 1926, and fortified wines were banned from 1917 to 1923. This period is often referred to as The Prohibition. The consumption of alcohol declined somewhat, but at a high price: Increased smuggling, moonshining and abuse of prescriptions. The latter was caused by the doctors' exclusive right to prescribe alcohol, which some doctors abused for the sake of personal gain. KNOWLEDGE BASIS: The article is based on a review of the records of the Storting's deliberations concerning prescription practices in the period 1916-1926, as well as articles on alcohol issues in the Journal of the Norwegian Medical Association from the same period. RESULTS: With the aid of increasingly strict regulations, the authorities sought to stem the activities of the so-called «whisky doctors¼. The restrictions and controls imposed on their prescribing rights turned out not to be very effective, however, since the doctors' rights were firmly established. In combination with weaknesses in the legislative base, this hampered the criminal prosecution of doctors who wrote prescriptions in a big way. The abuse reached its climax in 1923. It was only with the enactment of the Prescription Act which came into force on 1 March 1924 that the authorities finally succeeded in gaining control of the abuse of prescriptions. The sale of spirits on prescription subsequently dropped sharply. INTERPRETATION: The prescription of spirits had gradually spiralled out of control, and the repeated control measures enacted by the authorities proved insufficient. When the Prescription Act was finally adopted after three attempts in the Storting, time was in reality up for the prohibition.

«Would a doctor really endeavour to refuse a patient his cognac?!¼--doctors' prescription practices in the prohibition era 1916-1926.

BACKGROUND: In Norway, all sales of distilled spirits were prohibited from 1916 to 1926 and fortified wine was also banned from 1917 to 1923, a period of history called The Prohibition. During this time, the doctors served as gatekeepers who regulated the population's access to alcohol, since a prescription was the only legal way of obtaining fortified wine and distilled spirits. Many have claimed that the doctors failed in this role and undermined Norwegian prohibition policy. KNOWLEDGE BASE: The article is based on a review of articles on the alcohol issue published in the Journal of the Norwegian Medical Association. RESULTS: Many doctors were of the opinion that alcohol had beneficial health effects, for prevention and alleviation as well as to provide a cure. Moreover, few doctors were temperance advocates and many of them were opposed to the prohibition, including the Director of Health. Over time, many doctors prescribed large amounts of spirits and fortified wine. However, there were few real whisky doctors. The medical community was strongly in favour of rationing, i.e. letting people acquire a certain amount of alcohol without any medical supervision, but this proposal never gained political acceptance. INTERPRETATION: The doctors had a certain responsibility for this erosion of the prohibition, and thereby also for its final demise. The whisky doctors were a threat to the profession's reputation, and the most unscrupulous were excluded from the Norwegian Medical Association. The main responsibility for the situation with regard to prescriptions, however, fell on the health authorities and politicians, who delayed the introduction of effective regulations for far too long.

How ephedrine escaped regulation in the United States: a historical review of misuse and associated policy.

OBJECTIVE: Ephedrine is not only efficacious in the treatment of numerous ailments, but also has a long history of misuse. Research was needed to examine ephedrine policy over time in order to determine potential regulatory flaws that allowed misuse to continue. METHODS: This review is based on primary literature derived from systematic searches of historical and scientific archives, as well as grey literature. RESULTS: Ephedrine managed to pass through numerous regulatory loopholes within seventy years. Despite warnings of misuse over the latter half of the century, ephedrine, and its herbal source, ephedra, were regulated in a piecemeal fashion and remained easily available to the public. Health authorities have struggled to control ephedrine, as an amphetamine "look-alike," as a methamphetamine precursor, as a dietary supplement, and as a medication. Despite being a potentially dangerous stimulant, under-regulation was perhaps more problematic than the substance itself. CONCLUSIONS: Tighter control of all ephedrine products, drugs and dietary supplements alike, might have prevented adverse outcomes and allowed this substance to remain available in a safer manner. Stringent regulation of all ephedrine products is necessary to prevent misuse and to protect the public's health.