The Pharmaceutical Journal
Vol 274 No 7337 p216
19 February 2005

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Testing medicines by the swing of the pendulum more
Advertising medicines direct to consumers: mere information or subtle persuasion? more
Is the remedy in sight for hunger in our world? more
Let’s encourage the eccentrics! more

Testing medicines by the swing of the pendulum

We hear a great deal nowadays about the unexpected and undesirable effects of taking medicines, whether obtained over the counter or on prescription. They may interact with other medicines or with food, or they may have no discernible benefit for the sufferer. Moreover, there is a growing suspicion of the prescriber’s competence in some patients’ minds, and of the power of the manufacturer’s advertising tactics.

I recently came across a curious report of a method of testing a medicine’s efficacy in a folklore correspondence published just 50 years ago. Apparently a middle-aged bookseller, resident in Kensington, wrote that he was in the habit of testing any medicine he was prescribed by placing the bottle on a white sheet and suspending a pendulum above it. If the pendulum developed a clockwise motion, the medicine would prove beneficial. On the other hand, if the motion was anticlockwise, then it would have harmful effects and should therefore not be taken. If the swing of the pendulum was erratic, there would be no danger in the remedy, but it would prove ineffective for its purpose.

In case any reader wishes to resort to this test, I am advised that the ideal pendulum consists of a smooth gold wedding ring suspended on a silk thread. Details of the precise length of the suspension, and therefore of its period of rotation, are not available. Any GP who attempts to prescribe a deliberate placebo without telling the patient should heed the warning that detection of the subterfuge is possible without recourse to elaborate equipment.

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Advertising medicines direct to consumers: mere information or subtle persuasion?

The advertising of medicines available on prescription has always been the subject of argument. It has recently been criticised because of the rather doubtful matter of how much emphasis should be placed upon possible side-effects as compared with likely benefits. Some cyclo-oxygenase-2-inhibitors, notably rofecoxib, have had to be withdrawn from the market because of possible toxic risks and others, like celecoxib, have become controversial. Some litigation has raised the accusation that direct-to-consumer advertising has involved misrepresentation.

In the New England Journal of Medicine for 17 January, Ernst Berndt of the Massachusetts Institute of Technology has examined the question of how far drug advertising to consumers may proceed to persuade them, rather than merely inform them, regarding their choice of a remedy. There must always be a controversial element in advertising, but it takes on new proportions when it concerns health matters.

The evaluations of physicians regarding advertising directly to consumers are mixed, writes Dr Berndt, with 40 per cent believing that it helps prescribers in their practice, 30 per cent that its effect is negative and 30 per vent that it has no effect at all. However, it appears that there is strong support from patients for direct advertising. As they face increasing charges for drugs, patients feel a right to demand more information from the manufacturers.

Nevertheless, advertising may not only inform; it also tends inevitably to add an element of persuasion. Part of the problem is the inadequacy of the information offered. Direct advertisements make drugs seem better than in fact they are. A better balance of warnings against recommendations seems to be called for. Yet the question arises, how far a reader of information who cannot have inside knowledge of the jargon may be relied upon to make a sound interpretation of what is presented.

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Is the remedy in sight for hunger in our world?

In October 2002 the United Nations drew up what it called the Hunger Task Force. People came from varied backgrounds to discuss the matter, and both developed and developing countries were represented.

A report of the findings was published in Science for 21 January, and revealed that 854 million people worldwide (about 14 per cent of the total population) are chronically or acutely malnourished. Most of them live in Asia, but in sub-Saharan Africa there is a prevalence of hunger affecting some 30 per cent and the numbers of the malnourished continue to increase. Acute hunger receives most of the publicity and accounts for about 10 per cent of those affected, but there is also a hidden hunger from deficiencies of micronutrients, which affects more than two billion people.

In different regions there are different reasons for hunger. In tropical Africa and remote parts of Asia and Latin America low agricultural productivity may be a primary reason. Poverty and unemployment are main causes in South and East Asia, Central Asia and the Middle East.

The rule of law, low levels of corruption and respect for human rights are essential for achieving food security. Increased agricultural research has a major effect in reducing hunger. Restoration of soil health is called for and in some areas water management must be improved. Provision of genetically superior crops and livestock can greatly increase the productivity of small-scale farming.

To improve nutrition, women are particularly important as primary care providers in vulnerable communities. Attention should be focused on children under the age of two years and the supplementary feeding of pregnant and lactating women. Among children of school age and adolescents, free balanced school meals using local produce are recommended. Increased consumption of fruits and vegetables will reduce mineral and vitamin deficiencies.

Meanwhile, properly organised markets are critical in ensuring that farmers are able to earn an adequate income and sell their products at fair prices. With such developments hunger could be controlled by 2015 and eventually eliminated.

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And I quote…

Let’s encourage the eccentrics!
“Eccentricity has always abounded when and where strength of character has abounded; and the amount of eccentricity in a society has generally been proportional to the amount of genius, mental vigour and moral courage it contained. That so few now dare to be eccentric marks the chief danger of the time.”
—John Stuart Mill: ‘On liberty’ 1859.

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