{"id":7701,"date":"2022-12-07T16:27:38","date_gmt":"2022-12-07T16:27:38","guid":{"rendered":"https:\/\/sandbox2.foxtrotdev.com\/?p=7701"},"modified":"2022-12-07T16:30:21","modified_gmt":"2022-12-07T16:30:21","slug":"remembering-pharmacys-past-looking-back-at-pharmacy-and-the-kefauver-hearings","status":"publish","type":"post","link":"https:\/\/sandbox2.foxtrotdev.com\/?p=7701","title":{"rendered":"Remembering Pharmacy’s Past: Looking Back at Pharmacy and the Kefauver Hearings"},"content":{"rendered":"\n

Editor\u2019s Note: AIHP is introducing a new feature called <\/em>Remembering Pharmacy\u2019s Past, in which we will highlight previously published articles that recount aspects of pharmacy\u2019s long and colorful history. We begin this feature with an article by AIHP\u2019s former Executive Director, Greg Higby, PhD, originally published in the Fall 2017 issue of the AACP <\/em>History of Pharmacy SIG Newsletter. (Past issues of the newsletter are posted on AIHP\u2019s website at this link<\/a><\/strong>.)<\/em><\/p>\n\n\n\n

It is well known that Congress passed the Kefauver-Harris amendment to the Food, Drug, and Cosmetic Act in response to the Thalidomide tragedy of the early 1960s. Some background on Kefauver and his hearings into pharmaceutical price fixing provides context and inspires students to consider parallels with today\u2019s concerns about the cost of medicines.<\/p>\n\n\n\n

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C. Estes Kefauver<\/figcaption><\/figure><\/div>\n\n\n\n

In the 1950s, C. Estes Kefauver, was one of America\u2019s best-known politicians. As a senator from Tennessee, Kefauver favored civil rights legislation and championed the causes of the \u201clittle man.\u201d He made his name investigating organized crime during some of the earliest televised hearings. In 1956 he was a leading candidate in the pursuit of the democratic nomination for president. And while he failed in that effort, he succeeded in gaining the V.P. spot on the ticket with Adlai Stevenson. And after suffering defeat in 1956 to the Eisenhower-Nixon Republican ticket, he turned to investigating American big business, first going after the steel and auto industries. In 1959, Kefauver announced that his attention would be turning to the pharmaceutical industry. As is often the case in the history of drug regulation, a tragedy \u2013 this time the tragic side effects of Thalidomide \u2013 resulted in new legislation in 1962.<\/p>\n\n\n\n

It is important to remember the state of pharmacy practice in 1959. The prescription business had grown tremendously during the 1950s. Before then drug companies were not giants of commerce. Rather than selling blockbuster medicines, most of them had made their reputations selling pure chemicals or standardized herbal preparations. Companies like Squibb, Lilly, and Parke Davis had built close relations with pharmacy over the decades and had earned the trust of community pharmacists, who made up nearly 90% of practitioners. A post-War boom in new drug development, spurred on by antibiotic research, had made the prescription department a significant part of the average drugstore\u2019s cash flow for the first time. By 1960, the prescription department provided about 50% of an average store\u2019s business, with the other half coming from out-front sales of traditional goods: candy, magazines, cosmetics, greeting cards, and tobacco. The actual practice, however, was simple. Pharmacists filled prescriptions. Period. Clinical pharmacy in general practice was years away. A few months before Senator Kefauver opened up his hearings, pharmacists were upset to learn that the American Medical Association wanted doctors to ask for the name of drugs to appear on prescription labels. (At that time, prescription labels did not commonly contain the name of the medicine inside. Patients were expected to trust their doctors completely.) Pharmacy leaders opposed he idea, largely because pharmacists would be forced to talk with customers about their medicines. That was the doctor\u2019s job and expressly forbidden by APhA\u2019s Code of Ethics.<\/p>\n\n\n\n

Starting in late 1959 and throughout 1960, Senator Kefauver and his committee went after the drug industry on the issue of pricing.1<\/sup> Kefauver was convinced that the pharmaceutical industry was fixing prices on certain drugs, especially antibiotics. The executives of the major companies argued that just because the major broad-spectrum antibiotics like the tetracyclines and chloramphenicol all cost exactly the same amount as each other and had for a decade, it did not mean there was any price fixing. Kefauver did not buy their arguments.<\/p>\n\n\n\n

In sharp contrast with what might happen today, all elements of pharmacy lined up against Kefauver: The companies, of course, opposed his inquiries. National pharmacy organizations saw Kefauver as threatening to them as well, even though he pledged not to investigate practitioners. Community pharmacists, placed on the front lines defending what they identified as their industry to customers, opposed Kefauver. And the journals \u2026 well, they set aside objectivity and went after \u201cKeef.\u201d In the words of one head-line writer, \u201cKefauver Smear Campaign Begins.\u201d<\/p>\n\n\n\n

As Dan Rennick of American Druggist<\/em> remarked on the Kefauver hearings, \u201cno single event has created so much distress among pharmacists.\u201d He collated the opinions of his fellow editors who were all in complete agreement.2<\/sup><\/p>\n\n\n\n

Wally Werble (Weekly Pharmacy Reports<\/em> \u201cThe Green Sheet<\/em>\u201d):\u00a0 \u201cThe most damage that Kefauver can cause is to create a hostile atmosphere and public opinion for the pharmaceutical industry, drug wholesalers, and pharmacists.\u201d<\/p>\n\n\n\n

Madeline Oxford Holland (American Professional Pharmacist<\/em>):\u00a0 \u201cThe Kefauver hearings are a serious threat to all of Pharmacy.\u201d<\/p>\n\n\n\n

Robert Swain (Drug Trade News<\/em>):\u00a0 \u201cThe public may be expected to manifest a thumbs-down attitude for some time, as it munches upon the few juicy morsels tossed its way.\u201d<\/p>\n\n\n\n

Robert Abrams (Voice of the Pharmacist<\/em>):\u00a0 \u201c[T]hese hearings may serve as a springboard toward the hastening of some form of socialization of the health professions.\u201d<\/p>\n\n\n\n

Louis Kazin (Drug Topics<\/em>):\u00a0 \u201cRetail pharmacists should be prepared to answer the questions on prescription pricing that must be expected to crop up in ever greater numbers as the committee hearings progress.\u201d<\/p>\n\n\n\n

With these opinions expressed at the beginning of Kefauver\u2019s hearings, it is not surprising to learn that objectivity did not reign during the next several months. Following the lead of Dr. Austin Smith, head of the Pharmaceutical Manufacturers Association (PMA), the pharmaceutical press shifted towards a broad-based public relations campaign that emphasized prescriptions as \u201cAmerica\u2019s biggest healthcare bargain.\u201d The journals were full of articles and excerpted editorials critical of Kefauver and his \u201ctactics\u201d used against representatives of the drug companies. The editors of pharmacy journals even broke rank with their newspaper colleagues, accusing them of supporting Kefauver in order to \u201csell papers.\u201d\u00a0\u00a0<\/p>\n\n\n\n

As the hearings progressed in 1960 with Kefauver probing the pricing of corticosteroids and tranquilizers, pharmacy journals turned to harsher stories: The Kefauver hearings were going to dissuade young people from entering pharmacy, for example. The frightening specter of \u201cSocialized Medicine\u201d putting pharmacy practice under direct government control was brought out periodically whenever opposition to Kefauver seemed to cool.\u00a0\u00a0<\/p>\n\n\n\n

What was Kefauver\u2019s agenda? Was he hoping to ride this investigation into the White House, as some pharmacy editors maintained? Perhaps. He was an ambitious politician.\u00a0 But he also knew that his time had probably come and gone. More likely he saw reform of drug pricing as his legacy as a politician. He had found so-called \u201cadministered pricing\u201d in other industries and was convinced that the pharmaceutical industry was guilty of the practice. Moreover, the arrogance that Austin Smith and some company executives exhibited in the early rounds of the hearings spurred him forward.<\/p>\n\n\n\n

To the PMA Kefauver\u2019s hearings threatened to inspire laws that would impose some sort of price controls on drugs, especially lucrative antibiotics. Even more importantly, Kefauver\u2019s hearings brought public attention to the subject of generic prescribing and its possible cost savings. Outside of hospitals, almost all medicines were prescribed by trade name. Companies spent millions of dollars to make Miltown and Diuril household names.\u00a0 Anti-substitution laws kept brand name medicines large sellers long after patent rights expired. And finally, Kefauver\u2019s staff revealed another strange anomaly \u2013 brand name medicines manufactured by US companies were being sold wholesale in Europe and Canada at much lower prices than in the USA. The testifying pharmaceutical executives did not explain this oddity other than claiming that it was a result of the strong US dollar.<\/p>\n\n\n\n

Based on the hearings, Kefauver proposed corrective legislation in 1961 that clarified the length and nature of pharmaceutical patents, called for uniform generic names for drugs, and some regulation of drug advertising. Most significantly, it gave the Food and Drug Administration the authority to pass on drug efficacy as well as safety. The bill failed to receive sufficient support for a vote on the Senate floor. The public relations barrage by the PMA and supported by the pharmacy establishment may have contributed to its demise. It would, however, rise again.<\/p>\n\n\n\n

Soon after the bill\u2019s legislative defeat, the popular press filled their pages with stories and photographs of the victims of the Thalidomide disaster. This sedative, marketed in Europe to treat morning sickness, led to about 10,000 cases of phocomelia. Richardson-Merrill attempted to get the drug into the US market in late 1960 and was stopped repeatedly by Frances Kelsey at the US Food and Drug Administration. Few stories have captivated the popular press as the famed \u201cThalidomide babies.\u201d As was the case in the 1930s when the Elixir of Sulfanilimide disaster spurred passage of the Food Drug and Cosmetic Act, this new disaster resurrected Kefauver\u2019s old bill, which was re-written to add an efficacy requirement for new drugs. President Kennedy signed the bill on 10 October 1962.5<\/sup><\/p>\n\n\n\n

References:<\/p>\n\n\n\n

1.         Kefauver Hearings Spawn Massive Headline Assault on Drug Field Prices,\u201d American Druggist, December 28, 1959, p. 11.<\/p>\n\n\n\n

2.         Dan Rennick, \u201cStraight Talk,\u201d American Druggist<\/em>, February 22, 1960, p. 8.<\/p>\n\n\n\n

3.         How to do a Public Relations Job on Rx Prices . . . Right at Home,\u201d American Druggist<\/em>, November 2, 1959, p. 9<\/p>\n\n\n\n

4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Henry Steele, \u201cThe Fortunes of Economic Reform Legislation,\u201d American Journal of Economics and Sociology<\/em>, 1966, 25, pp. 39\u2013 51. doi:10.1111\/j.1536-7150.1966.tb02762.x<\/p>\n\n\n\n

5.https:\/\/www.fda.gov\/aboutfda\/whatwedo\/history\/productregulation\/promotingsafeandeffectivedrugsfor100years (Accessed 3 August 2017).<\/p>\n\n\n\n

Posted: December 7, 2022<\/p>\n","protected":false},"excerpt":{"rendered":"

Editor\u2019s Note: AIHP is introducing a new feature called Remembering Pharmacy\u2019s Past, in which we will highlight previously published articles that recount aspects of pharmacy\u2019s long and colorful history. We begin this feature with an article by AIHP\u2019s former Executive Director, Greg Higby, PhD, originally published in the Fall 2017 issue of the AACP History […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,10],"tags":[],"class_list":["post-7701","post","type-post","status-publish","format-standard","hentry","category-news","category-remembering-pharmacys-past-2"],"yoast_head":"\nRemembering Pharmacy's Past: Looking Back at Pharmacy and the Kefauver Hearings - American Institute of the History of Pharmacy<\/title>\n<meta name=\"description\" content=\"Advancing knowledge and understanding of the history of pharmacy and medicines.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sandbox2.foxtrotdev.com\/?p=7701\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Remembering Pharmacy's Past: Looking Back at Pharmacy and the Kefauver Hearings - 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