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and uses, can be in the least degree influenced one way or the other by the statement that "phenolphthalein has been popularized by nostrum makers." The phenolphthalein and succinate of soda combinations were originally both prescribed, and we have simply placed them at the service of the physician without other exploitation of them than that designed to call attention to their use in the conditions indicated. These combinations are offered in a form which may be administered by the mouth with the best promise of introducing the substance more directly in Purchase Paxil the intestinal Purchase Paxil tract during the digestion period or at such interval after or prior to, the digestion period, as would best, in the judgment of the physician, meet the indications. These particular combinations are especially desirable in these "fixed forms" since they are stable and reliable resources at the command of the physicians, the enzymes retaining their stability and potency without material deterioration for many years, and they naturally possess the advantages which are obviously due to the character of the particular pancreas and bile products used in the Purchase Paxil combinations. Furthermore, the hygroscopic and soluble organic substances in admixture Purchase Paxil cannot extem- poraneously be so prepared in sealed capsules as to be readily available under the practical requirements of prescribing and dispensing. And we do not believe that those who practice medicine will be in accord with your view that the pancreas substance should necessarily be administered alone, or the bile substance alone. It now appears that these combinations are to be dropped from New and Nonofficial Reme- dies in consequence of the view, so stated, that in clinical experience "for more than nine years there is no satisfactory evidence that they possess any advantage over the simple laxatives or preparations of bile or pancreatic extract." In reply to this we would simply make the following comment: During these "nine years" these combinations Purchase Paxil have inevitably been put to an informing clinical trial, because of the fact that they have been employed with success in disorders of the pancreas and bile functions and often in chronic and serious cases where the clinical conditions were obvious and unmistakable. The reports of these cases come to us from physicians widely separated and each of his own independent initiative. It would seem gratuitous, to say the least, to state that the observers are "disinterested," since it Purchase Paxil is quite clear that there is no other interest than that of the practi- tioner and his patient. It is not a case of a new drug or combinations of new remedies, but simply resources which, upon well grounded reasons, both from a theoretical and material standpoint, justify clinical trial, and with results which would seem from any ordinary human standpoint to be satisfactory clinical evidence. As to the interpretation of competent clinical evidence by the Council, we would, in view of the circumstances and without comment, ask to embody in this text this rule: "Clinical Evidence." "To be acceptable, the clinical evidence must offer objective data with such citation of authority as will enable the Council to confirm the facts and establish the scientific value of the conclusions drawn. Clinical data are worthless when the author is not cited. The facts on which claims with regard to the value of a remedy are based must have been rendered Purchase Paxil accessible for investigation and confirmation by disinterested observers, either through Purchase Paxil publication or through the records Purchase Paxil of a hospital or other insti- tution." To discredit these combinations would seem to us not only unjustified, but sterile of any real advancement in medicine, or of anything in the way of helpfulness to the patient in the class Purchase Paxil of cases in which these products have been resorted to with benefit j this on no other ground really than the opinion "that they have no advantage over the simple preparations themselves." Naturally we shall continue to prepare these products and shall continue to take such action as we deem best to bring them to the attention of the physician, for the conduct of our business must remain in the hands of those who are personally responsible for it. Purchase Paxil And it is now forty years since we took up this line of work and Purchase Paxil with the declared intention of devoting ourselves to the applied science of the digestive ferments and "to their development and practical application in every useful purpose in medicine." We have been consistently in sympathy with the fundamental purpose of the Council, which must first rest upon fact as to the character of the products offered as medicinal agents. The 210 PROPAGANDA FOR REFORM weight of evidence justifies the position that these particular products rationally should be, and as a matter of fact are, of important special service in the utilization of these organic secretions in medicine. As explained in the preceding report, the Council holds that complex mixtures of remedial agents are from every point of view inimical to therapeutic progress and therefore to the public welfare. They are especially objectionable because it is impossible to determine accurately the effects which follow the simultaneous administration of a number of drugs having dissimilar actions, and because such a practice tends strongly to discourage careful consideration of the special needs of individual patients without which there can be no therapeutic progress. On the contrary, with their use, therapeutic treatment becomes haphazard and mere guesswork. The dismissal of the holadin and bile salts mixtures does not involve the question of the usefulness of holadin or of bile salts alone; on the contrary, the possible usefulness of these preparations is admitted in the report. It is the combination of holadin, bile salts, sodium succinate and phenolphthalein to which objection is made. The statement of Fairchild Bros, and Foster that "these combinations are now further justified in view of physiological considerations" is somewhat misleading. It is true that bile and the pancreatic secretion cooperate in intestinal digestion, but there is no evidence that in every case in which there is a deficiency of one of these secretions there is also a deficiency of the other, and it is an axiom of scientific therapeutics that no drug or remedial agent should be administered except to fill a definite want. Otherwise the practice of therapeutics becomes mere empiricism. The properties of phenolphthalein are not in the least influenced by the manner of its introduction, as Messrs. Fairchild Bros, and Foster emphasize; but the important fact in this connection is that the popular conception of their actions is greatly influenced by the mode of introduction, and phenolphthalein has been widely advertised in a variety of conditions, so that the popular notion concerning it is not that of scientific therapeutics. In short, the entire argument of Messrs. Fairchild Bros, and Foster con- cerning the exploitation of these preparations may be summed up by saying that they have been used by clinicians who believe that good results have followed their use, and that the firm will therefore continue to supply the demand. The tendency of some to use anything brought to their notice, and the readiness of manufacturers to market anything that physicians will use, presents the greatest obstacle to therapeutic progress. There was never a nostrum so irrational or worthless that honest but undiscriminating clinicians could not be found who reported wonderful results from its use. According to Fairchild Bros, and Foster, these holadin and bile salts
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