The Pharmaceutical Journal
Vol 276 No 7387 p182
11 February 2006

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Mysteries of the blue and orange men more
Dictatorship in the drug industry more
Fundamentalism and fanaticism more

Mysteries of the blue and orange men

Berton Roueche, a native of Kansas City, Missouri, was born the son of a businessman in 1911, and was described by family and friends as an easy-going man with a passion for reading and writing. Until his work caught the approving eye of the editor of The New Yorker in 1944, he worked as a journalist in Kansas City and St Louis, thereafter writing for the magazine until his death in 1994. His taste for stories carried him into strange contexts, described by Barron Lerner of Columbia University in a commentary in the 8 December 2005 issue of the New England Journal of Medicine.

Roueche’s first and most famous medical story relates to a group of gravely ill blue men who attended a New York hospital and were found to be cyanosed, having been fed oatmeal made with sodium nitrite instead of sodium chloride in a New York cheap cafeteria. A later story described an orange man who had developed this pigmentation after excessive consumption of carrots and tomatoes. Yet another featured an outbreak of trichinosis resulting from the eating of uncooked pork at a German-American festival. And then there was the story of the dry cleaner who suffered liver failure after using carbon tetrachloride as a solvent.

The common feature of all these stories drawn from life was the elucidation of the cause of mysterious illnesses through the application of clever detective work. Roueche’s comments likened his pieces to the complex problems featured in the Sherlock Holmes tales of Arthur Conan Doyle. At the time, the notion of the medical detective arriving at diagnoses was a recent one. The history of medicine, argued the author, included a record that the bubonic plague had at different times been attributed to the misalignment of the planets, purported sins of the Jews and the wrath of God, rather than to a bacterial infection.

The growing interest in epidemiology gave Roueche’s medical stories a great appeal and made their author into something of a folk hero. He threw much light upon the side effects encountered in recent therapies with agents such as corticosteroids and his stories even entered the curricula of medical and public health schools, since they were enjoyed by medical students.

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Dictatorship in the drug industry

The Government has failed to respond adequately to the report last year of the House of Commons Health Select Committee inquiry into the influence of the pharmaceutical industry, according to Joe Collier of the University of London, who is an adviser to the committee.

Writing in The Lancet for 14 January, Dr Collier says that the inquiry, which began in June 2004, revealed much evidence about the industry’s influence on how health professionals can determine issues of public health. Briefly, he concludes that this influence is “enormous and out of control”. It is directed at patients, health departments, regulators, managers, researchers, medical charities, academics, the media of mass communication, carers, schoolchildren and politicians. Moreover, large multinational drug companies design, sponsor, orchestrate and control the publication of key drug trials, and they promote the medicines we take and virtually how they are prescribed.

Among the committee’s recommendations was a call for a public inquiry into the workings of the Medicines and Healthcare Regulatory Agency, which committee members considered was not competent to undertake its duties as a guardian of public health. However, the Government declined such an inquiry in favour of a four-yearly review based on expert knowledge.

In response to other recommendations, health agencies are to examine drug promotional material to improve efficiency and damp the explosive marketing that accompanies product launches. The circumstances in which UK licensed medicines are withdrawn are also to be published. A recommendation that official sponsorship of the drug industry should be moved from the Department of Health to the Department of Trade and Industry was rejected, although many MPs see the current situation as involving a conflict of interest.

The Government also rejected a proposal that drug launches should be delayed until full clinical trials have appeared on a public register. Problems with EU legislation were cited but, says Dr Collier, the real reason is that the move would interfere with drug company sales.

Dr Collier concludes that the welfare of patients will remain vulnerable so long as the influence of big business interests continues to dominate health policies and practice.

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Fundamentalism and fanaticism

In New Scientist for 8 October 2005 there appears a group of commentaries on the subject of fundamentalism. This is a matter for serious concern.

Fundamentalist movements are making ever deeper impact across the Muslim world and beyond, while Christian fundamentalism in the US in particular is showing increasing political and cultural power. Moreover, the tendency is arising within cultures affected by Judaism, Buddhism and Hinduism. Only in Western Europe is there less evidence of the growing tendency.

Fundamentalist movements apparently have little in common, with the Christian and Islamic manifestations appearing in opposite camps. They seem to be reactions against secular influences that have grown strong in the modern world. They involve the belief that they alone know the truth about the world, and tend to rely on a literal interpretation of a sacred text. The trouble is that the individuals concerned are driven to impose their notion of truth upon others, and they are unable to tolerate dissent from any quarter.

The dictionary meaning of “fundamental” is “essential, or serving as a groundwork”. In its religious aspect it originated in Protestant bodies in the US after 1918. Francis Bacon in his “Novum organum” of 1620 explained its rationale thus: “For what a man would like to be true, that he more readily believes”.

In 1950, Bertrand Russell extended this idea by explaining that: “Man is a credulous animal, and must believe something; in the absence of good grounds for belief he will be satisfied with bad ones”. It is claimed that a traditional religion is characterised by being geared to the needs of people in a traditional agrarian society. If so, we must admit that we have not unlimited choice in what we are brought up to believe.

We can, of course, choose scientific rather than religious fundamentalism. This teaches that the world is accessible to and controllable by human reason, but this idea is neither provable nor refutable. Scientific fundamentalism offers us dreams of competence and therefore expects too much of this world; religious fundamentalism expects too much of a future life.

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