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How should FDA regulate prescription drug promotion on the Internet?

The current scheme for regulating prescription drug labeling and advertising developed in a world in which information was centralized, static, and one-dimensional. Advertising was merely incidental to other activities such as reading magazines or watching programs. The Internet-wired world is different. Information is now instantly, globally accessible. Consumers can search through varied levels of detail on almost any topic. Anyone can join the fray by publishing their own materials on the Internet. This article addresses the unique problems raised by any proposed regulation of prescription drug labeling and advertising on the Internet. In particular, the article reviews the history, culture, technology, and popular uses of the Internet, and examines some of the models for regulation presented at an October 1996 Food and Drug Administration (FDA) conference on regulation of Internet content. Finally, the article suggests a new direction for regulation prescription drug promotion on the Internet.

Advertising↗

Sozodont powder dentifrice and Mrs. Winslow's Soothing Syrup: dental nostrums.

The Great Patent Medicine Era (1865-1907) was the golden age of secret remedies--quack, non-prescription medicinal products, sold over-the-counter. Making outrageous and unsubstantiated claims, the makers of dental nostrums purported to effectively treat stained teeth, bad breath, diseased gums, toothache and teething discomfort. No proof was required to substantiate the safety and effectiveness of these concoctions. Advertisements for patent medicines were widespread, appearing in newspapers, almanacs, magazines, trade cards and multiple other media forms. Many dental patent medicines contained acids, abrasive substances, alcohol and/or narcotics, such as heroin, cocaine and morphine. Sozodont Tooth Powder, the most widely promoted and successful dentifrice of this era, claimed to "harden and invigorate the gums, purify and perfume the breath and beautify and preserve the teeth from youth to old age." Early dental researchers found that this remedy contained harsh ingredients (such as acid, sharp abrasives and astringents) which could destroy tooth substance. Mrs. Winslow's Soothing Syrup, an extremely popular dental nostrum, was intended to quiet a fretful child during the teething process. However, it contained generous levels of alcohol and morphine sulfate which could cause coma, addiction or death in an infant. Although somewhat chemically altered, these two products were eventually removed from the market in the 1930s.

Analgesics, Opioid↗

Educational partnerships: a viable solution to the health care employee shortage.

It is difficult, if not impossible, to pick up a health care magazine today without finding an article concerning the shortage of health care professionals. Creative ideas for recruiting new hires, sign on bonuses and employee referral programs are commonplace. However, one significant solution is rarely reviewed--developing genuine partnerships with educational institutions to assist with employee advancement programs.

Career Mobility↗

Rebuttal to TV show: "coffee, tea or radiation".

On 22 October 1974, CBS News presented a segment "Coffee, Tea or Radiation" on its program "Magazine". The program focused on the hazards of transporting radioactive materials by common carrier, especially by air. The presentation provoked strong reaction among some knowlegeable individuals. The text o this article is a letter sent by the author to Perry Wolf, CBS News, New York. A copy was made available to the American Society of Non destructive Testing through Walter P. Peeples, Jr., president, Nuclear Environmental Engineering, Inc., Houston, Texas.

Humans↗

[The dispute over eugenics in interwar Poland].

The eugenic problem seems not as well known as it was in the period between the world wars. The word "eugenics" was introduced into the scientific language by the British biologist, Francis Galton at the end of the XIX century. In general, it means the study of the methods of protecting and improving the quality of the human race by selective breeding. Galton's remarks initiated a wider (social and political) movement, which was active in some countries. The eugenic tendency was visible in American immigration policy before the Great War - making it difficult for people suffering from particular diseases to enter the USA. After the war, the eugenic movement became much stronger. In some countries (e.g. Sweden, Norway, Finland, Denmark, Switzerland, Germany, and over half of the states of the USA) some components of the eugenic programme were introduced into legislation. The eugenic movement also appeared in reconstructed Poland. In 1918 it published it own magazine "Zagadnienia Rasy" (Problems of Human Race), later "Eugenika Polska" (Polish Eugenics). This did not imply however, that interest in the eugenic programme was generally very strong. In fact, it was limited by the influence of the Catholic Church. Another significant factor was lost Polish - German hostility. In the late thirties eugenic slogans lost popularity because of their use in Germany racist policy.

Eugenics↗

[Smoking as a theme in popular health literature 1940-1960].

BACKGROUND: Little is known about the information available to smokers who started smoking in the early days of research on smoking and health. The main topics of investigation in our study were: How much information on the health hazards of smoking was available to non-professionals in Norway between 1940 and 1960? What characterised this information, and did it change in quantity or quality over this period? MATERIALS AND METHODS: Representative samples of health magazines and books from 1940 to 1960 were analysed for information on the health effects of smoking. Frequency and size of articles were registered and a basic statistical analysis of the information performed. RESULTS: There was a slight increase in the amount of literature published on the subject. Religious publications were the most direct in their communication and the most consistent in recommending non-smoking. Compared to other publications, they eagerly speculated on underlying physiological mechanisms. The non-religious publications seem to better reflect the general discussions and disagreements in the field; according to several, only "exaggerated" smoking constituted a threat to health; "moderate consumption" was considered harmless. INTERPRETATION: While religious literature engaged in overt and sometimes undue speculation, the non-religious publications in the sample seemed to reflect a belief in the harmlessness of a "normal" consumption of cigarettes. The debates and disagreements in the scientific community are also more apparent in the non-religious publications.

Attitude to Health↗

Self-esteem matters: racial & gender differences among rural southern adolescents.

Self-esteem does matter! It matters so much that Oprah dedicated an entire issue of "O" magazine to address the subject. "It's a woman's most treasured possession" (Winfrey, 2000a). Self-esteem has a profound influence on adolescent health promotion behaviors. This study contributes to understanding the role self-esteem plays in the behavior of adolescents. Utilizing a secondary data analysis, race and gender self-esteem differences among adolescents were investigated. The sample of 1,237 students (46% African-American and 52% White) from rural southern areas consisted of 744 females and 493 males. Self-esteem was assessed using the Miller Self-esteem Questionnaire (SEQ). The Hendricks Perceptual Health Promoting Determinants Model (HPHD) provided the theoretical framework for the study. The results of the study revealed a statistically significant difference in various aspects of self-esteem according to race and gender. African-Americans and males had a higher self-esteem which is consistent with many prior studies.

Adolescent↗

Five-star service.

For the second part in the series of articles featuring human resources initiatives in Michigan hospitals (part one appeared in the November/December issue of Michigan Health & Hospitals magazine), the spotlight is on Lakeland Regional Health System, with three hospitals in southwest Nichigan. It has changed its culture of care to be more oriented toward service.

Hospital-Patient Relations↗

[Topics in clinical dentistry. Trends in the Dutch dental literature].

Aim of the study was to evaluate a method for selecting topics suitable for developing dental clinical practice guidelines in the Netherlands, based on an analysis of Dutch dental journals. A search for dental clinical topics was conducted by analysing Dutch dental journals, magazines and series over the period 1992-1997. The numbers of publications per topic were plotted against the publication years. The number of publications as well as the value of the slope of the linear regression were considered to be indicators of the importance of a topic. 'Dental implants (indication)' had the highest number of publications, followed by 'orthodontic treatment planning' and 'periodontology (indication)'. The topic 'practice hygiene' showed the highest value of the slope of the linear regression, followed by 'TMJ dysfunction' and 'dental implants (indication)'. With this method, it is feasible to detect changes and tendencies in the Dutch dental literature. It permits a selection of clinically relevant topics over a time span. It was concluded that this method may be very useful in the selection of a topic, but should probably be combined with other methods.

Dental Implants↗

[Projection and representation of scientific France in the Eastern Portuguese Empire: the correspondence exchanged between the Boletim General de Medicina e Pharmacia of the medical-surgical School of Nova Goa and the Faculty of Medicine of Lille].

This article approaches the projection and representation of scientific France in the Eastern Portuguese Empire. It deals, more precisely, with the correspondence exchanged between the Boletim Geral de Medicina e Pharmacia of the Medical-Surgical School of Nova Goa and the Faculty of Medicine of Lille. The ancient colony of Portuguese India presented a certain tradition in the publishing of medical-pharmaceutical magazines in the period between the second half of the nineteenth periodical approached certain themes of professional nature and included some articles of scientific nature with a special emphasis to certain aspects of tropical medicine and pharmacy. In Boletim Geral de Medicina e Pharmacia, it is possible to find the influence of French scientific culture on that ancient Portuguese culture. The exchange of correspondence between the Medical-Surgical School of Nova Goa and the Faculty of Medicine of Lille after World War I shows the solidarity which existed between these two institutions. It also shows the high consideration showed by the School of Nova Goa to the Faculty of Medicine of Lille and to French science and culture in general, universally recognised by the creative capacity of innovating in the service of common well-being.

Colonialism↗

[Pedro Laín Entralgo, physician and humanist].

This speech of the president of the Chilean Academy of Medicine, Dr Alejandro Goic, is a tribute to the memory of the Spanish physician, scholar, historian, writer and intellectual Dr. Pedro Laín Entralgo, who died in Madrid on June 4, 2001, at the age of 93. On that occasion, the Spanish newspaper "El Pais" defined him as the last humanist. The Spanish civil war started when Laín was 28 years old and he aligned with Franco's supporters. In 1940, when he founded the magazine "El Escorial", he was separated from the official party. He and other intellectuals declared themselves in an "interior exile". His autobiographical book, "Lightening the burden on the conscience" refers to his painful personal history. He obtained the History of Medicine chair, at the Complutense University, at the age of 34 and remained at that post until his retirement in 1978. His intellectual production is magnificent and calls to a mutual understanding, hope, friendship and love. Outstanding, among others, are his books "The wait and hope", "Theory and reality of the other", "Spain as a problem", "Medicine and history", "The clinical history", "Patient physician relationship", "Medical anthropology". He directed the collective work composed of seven volumes, called "Universal History of Medicine". He was a member of the Royal Academies for Language, History and Medicine. In Chile, he was named honorary member of the Faculty of Medicine of the University of Chile and of the Academies of Language, History and Medicine. He dictated a course of Medical Anthropology that had a profound impact on the thought of Chilean physicians. In 1949 he wrote that Chile was the most solid state of Latin America and that "Chile needs to leave his traditional calm, through a historical gesture, and create the river beds required by his magnificent spiritual and geographical gifts. There is a lack of a beautiful craziness". It was an invocation for an understanding with our neighboring countries "for ever and ever".

Anthropology↗

Maclean's rankings of health care indices in Canadian communities, 2000: comparisons and statistical contrivance.

A critical perspective is presented in regard to the 2000 regional rankings of Canadian health care indices by Maclean's magazine, June 5, 2000. This perspective is related in format to previous analyses of the Maclean's rankings of Canadian universities. Several pitfalls in the health care ranking procedures are summarized. The Maclean's data and general criteria appear conceptually reasonable, but their inconsistencies and limited range, together with problems in interpretation of rank data, do not allow them to be logically or empirically useful in the matter of health care evaluation, that is, in the manner portrayed for readers of Maclean's. Using a particular set of parameters defined as health "indicators," the rank data show gratuitously that communities better endowed with certain health services, such as those with medical schools, tend to provide higher levels of care.

Benchmarking↗

Factors affecting the match rate of rural training tracks in family practice.

BACKGROUND AND OBJECTIVES: Rural training track (RTT) family practice residencies are designed to prepare family physicians for rural practice. Residents in these programs spend 1 year in an urban location, followed by 2 years in a rural setting. Anecdotally, one hears that some programs have problems filling their available positions for residents. No published studies have systematically evaluated this fill rate. This study determined the match rate of rural track family practice residencies and examined factors associated with higher rates. METHODS: Questionnaires were mailed to program directors of all 28 rural track residencies identified in 1998 by the Residency Review Committee for Family Practice. Five programs proved ineligible, and 22 of the 23 eligible programs responded (96%). Directors provided information on fill rates and program characteristics from 1996 through 1998. Programs' reported fill rates were compared to rates previously reported for family practice residencies as a whole. Descriptive statistics were used to compare rural track programs that did and did not fill through and after the National Resident Matching Program (NRMP) (the "Match "). We also report data recently updated to reassess the situation for the 2001 Match. RESULTS: Rural track residency programs offered 52 first-year positions in 1998. All positions were offered through the NRMP. From 1996 through 1998, programs had a mean Match rate of 61%, compared with a rate of 86% reported previously for all family practice residencies. RTT programs in more-desirable communities (as determined by location near a listing in Fortune Magazine's "Best Places to Live") and those in the western and northeastern United States filled more positions than programs in less-desirable locations and in the southern and central United States. There were no other differences in the characteristics of programs or their faculty between programs that filled their positions and those that did not. These same trends held true for the 2001 Match. CONCLUSIONS: In recent years, rural track residencies were less likely to match their first-year positions than other family practice residencies. Geographic and community characteristics seemed to influence the Match rate, whereas characteristics of programs and their faculty did not.

Education, Medical, Continuing↗

[Graft-versus-host disease and xenotransplantation].

OBJECTIVE: The pathogenesis, mechanism, manifestation and diagnosis of graft-versus-host disease(GVHD) are reviewed in this article. METHODS: The relevant articles in recent public magazines were reviewed and summarized. RESULTS: It was indicated that GVHD occurred in the conditioned recipients in animal experiments and clinical transplantations. Humoral and cellular factors were involved in GVHD, which could be diagnosed and classified according to their characteristics. CONCLUSION: As a kind of interactions between the host and donor, GVHD are severely harmful to the host. It may also occur in xenotransplantation, where GVHD can be utilized in the studies on transplant immunology, oncology etc. Xenogeneic GVHD is receiving more and more attentions.

Animals↗

Rules to follow before advising patients on dietary supplements/alternative medicine: Part II.

Five rules for health care professionals to follow when patients inquire about complementary/alternative medicine are outlined. Suggestions include having health care professionals direct patients toward more objective medical articles such as reviews and editorials and to encourage patients to bring various advertisements and claims made by certain companies to the clinic so that health care professionals can analyze their overall merit. The Food and Drug Administration should be contacted by any health professional who has observed a negative or positive reaction with any dietary supplement. Health care professionals should read several alternative magazines and journals to better understand what patients are reading. Finally, patients should be assured that data gathering on some of these alternatives are being collected at a rapid pace that should promote a better understanding of the benefits and detriments of certain supplements.

Clinical Protocols↗

Autoerotic asphyxia (a case report).

The authors report the case of a young man, 18 years of age, who died as a result of autoerotic asphyxia. In the practice of forensic medicine such cases are presented as deaths from mechanic asphyxia in which, using various means and devices, the neck is constricted or the external respiratory orifices are obstructed with the purpose of achieving sexual gratification as a result of the induced hypoxia. These cases pose serious difficulties to the forensic medicine expert and the coroner because of the difficulties of distinguishing it as homicide, suicide or accident. The young man was found hanging by the neck, suspended on a leather belt attached on the door of his room. A mirror was placed in front of the door, reflecting him in full height. He was dressed in women's clothing (a skirt, a blouse, bikini) and a brassiere padded to resemble female breasts. Pornographic pictures from newspapers and magazines were spread on the floor. The young man had no known history of mental disorders, but there was evidence for bisexual tendencies and behaviour. On the basis of a comprehensive evaluation of the data it was accepted that the death was accidental and was attributed to autoerotic asphyxia. All the characteristic features for an act of autoerotic asphyxia, described in the forensic medicine literature, were found in this case. Autoerotic asphyxia is almost unknown as a distinctive psychopathological entity in this country's forensic medicine practice. The deficiency of theoretical knowledge in this field, as well as the lack of personal practical experience in most of the legal physicians and pathologists could result in erroneous interpretation of such case.

Accidents↗

[The life of Dr. John William Heron, the second superintendent of Chejungwon].

The purpose of this paper is to overview the life of John W. Heron, M. D. who was the first appointed medical missionary to Korea by the Presbyterian Church USA. Although he was a competent doctor as well as a devoted missionary, he is not well-known yet, because he died early after 5 years' service in Korea. Dr. Heron was born in Derbyshire, England on June 15, 1856. His father, Rev. E. S. Heron, was a Scotch Minister of Congregational Church. His family emigrated to America in 1870 when he was fourteen years old and settled in Knoxville, Tennessee. In 1881, he was admitted to the University of Tennessee Medical School and graduated with highest honors in 1883. After training in New York University Hospital, he refused the offer of professorship from the University of Tennessee to become a medical missionary to Korea. He arrived in Seoul on June 21, 1885 and began to work in Royal Government Hospital, Chejungwon, the predecessor of Severance Hospital. In 1887, he became the superintendent of the Hospital following Dr. Horace N. Allen. He also worked for the Royal family and sometimes traveled to the rural areas to care for the patients. He started Chejungwon Church which later became Namdaemoon Presbyterian Church. In 1887, Dr. Heron worked as a member of the Bible translation committee and in 1889, he was elected as the chairman of the Public Committee of the Presbyterian Churches. In 1890, he established 'The Korean Religious Tract Society (Chosunsyungkyoseohoi) with Underwood and Ohlinger. The society published and replenished Christian books, periodical magazines and booklets. In the Summer of 1890, Dr. Heron did his best to take care of the sick suffering from an epidemic dysentery and himself got infected because of the terrible overwork. He passed away on July 26th, 1890. On his deathbed, he told his soldier and native friends around him as follow: "Jesus loves you. He gave His life for you. Stand by Him!" The martyrdom of Dr. Heron should be remembered in the Korean history of mission, because he was the first victim among the foreign missionaries who had lived and worked in Seoul for Korean mission. Dr. Heron's mind of love, service and devotion should be remembered by the medical doctors working today in caring for the patients suffering from physical and spiritual illnesses.

History, 19th Century↗

Putting a price tag on children.

"This chapter shows that...there are many different aspects to the cost of a child and...many different measures have been developed. The chapter...argues that theories of fertility need to specify carefully the definition of child costs and that the assumptions underlying existing measures need to be made plain.... The review is divided into three major sections: babies, childcare and children. The sources covered range from popular magazines and Mothercare catalogues to the only large-scale official [U.K.] survey of maternity and its costs, undertaken in 1946. The items covered range from the price of babies' essentials to the fees at schools...as well as the costs of maintaining a child at university."

Adolescent↗