The labeling of medications.

Although Circulation is primarily a repository for original papers, one's resolve to keep it pure is repeatedly eroded by the claim of mundane problems of practice to attention in its pages. In the terminology of Fox,1 one's goal is to have a pure "recorder" joumal but, occasionally, "newspaper" objectives have claims to space that are difficult to deny. I wish to draw the attention of specialists in cardiovascular diseases to the positive recommendation by the Council on Drugs of the American Medical Association, that drugs be labeled. This was reaffirmed in a recent report, "To Label or Not To Label."2 The original resolution was The Council resolves that it favors labeling of prescriptions as a general practice, and furthermore, it is recommended that prescription pads contain boxes for a yes or no on whether to label; if these boxes are not filled in by the physician, the prescription will be labeled. The objections to such a standardized practice are fairly answered. Because more than a few drugs utilized by cardiologists have occult toxic effects and because others cause severe reactions manifested by disorders of the circulation, cardio-vascular specialists must know the nature of medications the patient has been taking, not only at the time of the examination but also in the previous months. The hazards related to the use by the patient of anticoagulants, quinidine, and digitalis are, or should be, well known to physicians. The hazards increase in magnitude with the increasing travel by patients, the growth of group practices, and the increased propensity of injury and not infrequent need of surgical treatment. Particularly with the elderly whose memories may be failing and who may be using numerous nos-trums, the physician may be especially frustrated. It is trite to say that, only by being aware of the medications his patients are taking, can the physician be alerted to possible bizarre reactions from their long-term use in susceptible subjects. The potential nefarious effect of drugs, for example acetophenetidin (phenace-tin), triparanol (MER-29), and hydralazine hydrochloride (Apresoline), was only accepted as valid, after gradual accumulation of rare cases. Can a contributory etiological role of methysergide maleate (Sansert) in valvular disease, as now suspected by me, or of contraceptive medications in thrombotic episodes perhaps be supported similarly by the collection of exceptional cases? (It is obvious that labeling is without value unless it be read; for example preparations of potassium salts and of …