Dr. APPLE. Several years ago we supported a manufacturers' identification bill, which was finally enacted by the California legislature. This eventually permitted the California Pharmaceutical Association to identify the multiple source firms, and that information was subsequently taken by APhA and prepared in table form and nationally distributed. For example, take chloral hydrate which is made only by one firm and distributed by a number of firms at various price levels.

We have tabulated this information and widely disseminated it to pharmacists.

Mr. GORDON. Could you supply that for the record?

Dr. APPLE. Yes.

[Subsequent information was received and follows:]

During the testimony which I and my associates presented
on behalf of APhA before the Subcommittee on November 15,
1977, we made reference to a number of documents or

publications. In this regard, you requested that we
submit copies of these items to you for inclusion in the
Hearing Record.

In accord with your request, I am hereby enclosing:

a.

A set of five mimeographed tables of information compiled by APhA staff for the purpose of refuting the various purported advantages of identifying drug products by brand or trademark names. Specifically, we referred during our testimony to Table IV which is a representative sample of drug products in which one manufacturer produces the product indicated for multiple distributors who, in turn, market that product under their own identity and at widely varying wholesale prices.

b. A photocopy of page 14 from the periodical, Drug Topics, of September 15, 1977 with a published status report of legislation to amend the antisubstitution laws on a state-by-state basis.

-1

2215 CONSTITUTION AVENUE, N.W.. WASHINGTON, D.C. 20037 • (202) 628-4410

CABLE ADDRESS: AMPHARMA

c. A photocopy of the July 9, 1973 editorial in the Journal of the American Medical Association which specifically refers to the APhA policy position with respect to drug product selection by the pharmacist and which, from its title, makes evident that AMA opposition stems from the perceived erosion of physician authority. (The four references at the end of this editorial provide a convenient listing of prior editorials appearing in the AMA journal which earlier denounced the APhA position.) A typical drug press report pertaining to this editorial appeared in the September 15, 1973 issue of American Druggist Merchandising beginning on page 64, entitled AMA Urges MDS to Fight Substitution Moves, a copy of which is also enclosed.

d. During our testimony, we also mentioned that the American Medical Association House of Delegates passed a resolution during its June 15-18, 1975 meeting urging every physician to write "don't substitute" on all of their prescription orders. The resolution referred to was resolution number 43 on the subject of "Generic Drugs," and we are enclosing copies of two typical pharmacy press stories reporting on this action. They are page 30 of the August 1975 issue of American Druggist and page T&G 2 of the June 23, 1975 issue of F-D-C Reports. Analogous action was also taken by several state medical societies and, as an example, we are enclosing page 175 of the March 1975 issue of Michigan Medicine which urges the physicians in that state to write "D.A.W." on each prescription in order to prohibit drug product selection.

e. We mentioned the greatly exaggerated and completely undocumented, wild statements made by certain medical groups as alarmists tactics. Specifically, we mentioned the efforts of the Congress of County Medical Societies (and the journal, Private Practice) conducted early last year in the State of Oklahoma and which you indicated the Subcommittee was already familiar. We also called attention to the testimony presented in July 1977 by the American Council of Medical Staffs/ American Association of Councils of Medical Staffs of Private Hospitals, and a photocopy of their July 27, 1977 news release is enclosed. As the first of a listing of "key points" of their testimony, they alleged that 35,000 patients died in two years "from government sponsored generic heart drugs."

f. As examples to support our opinion that individual physicians--in contrast to organized medicine--are either neutral on the question of drug product selection by pharmacists or may even favor it, we made reference to two survey reports, copies of which are enclosed. The first of these is dated March 1977 and was conducted at the University of Minnesota; this survey reports 62.8% of physicians supporting drug product selection by pharmacists. The second is a survey reported in AMA's own publication, American Medical News, page 5 of the October 24, 1977 issue, in which they report on a pol' conducted by the AMA's Center for Health Services Research and Development which indicates 46.0% of physicians were in favor and 5.5% had no opinion with regard to drug product selection by pharmacists.

I trust this provides the Subcommittee with all of the supporting documentation requested. Please let us know if we can be of further assistance.

Fisons