Development of a rational practice of therapeutics.

Wolfson Unit of Clinical One hundred and fifty years ago most treatments were Pharmacology, developed either from a naive (and often erroneous) Department of view of disease processes and aetiologies or from Pharmacological Sciences,.Ph.a Ss anecdotal observations of the beneficial effects of University of Newcastle upon Tyne, Newcastle particular remedies in individual patients. Treatment uponTyne NE1 7RU was thus based on a combination of hypothesis and Michael D Rawlins, FFPM, empiricism. professor of clinical Professional scepticism and public concern about pharmacology the state of therapeutics emerged around the turn of the century and underwent its catharsis in 1909. In BrMedJ 1990;301:729-33 that year the BMA published, in popular form, an expose, entitled Secret Remedies,of some of the patent medicines promoted to the public.' At that time the patent medicine trade was bringing personal fortunes to the innovators, appreciable excise duty to the exchequer, and considerable advertising revenues to the popular national and provincial press (with the notable exception of the Spectator). Manufacturers' claims were extravagant, and Beecham's pills (containing only aloes, ginger, and soap) were, for example, promoted for indications that included "maladies of indiscretion, kidney and urinary disorders, and menstrual derangements."2 Despite the fact that many newspapers (including the News of the World) refused to carry advertisements for Secret Remedies its sales exceeded the association's wildest expectations, and to meet public demand it ran to five impressions in three months. A successful sequel entitled More Secret Remedies appeared in 1911, and parliamentary concern lead to the appointment ofa select committee to examine patent medicines. The committee sat during three sessions of parliament and heard evidence from many sources. The witnesses included Sir Joseph Beecham, who underwent a hostile public cross examination. The committee was particularly worried over claims that Sir Joseph's