John Morgan, MD, died recently. He was an authority on the largest mass poisoning in US history, and his legacy is a warning about lax regulation.[1] In 1930, a patent medicine, Jamaica Ginger, known as “Jake,” which had a high alcohol content, was adulterated by a Boston manufacturer seeking to avoid regulation under Prohibition. The adulterant was a neurological poison that produced a distinctive limp known as “Jake leg,” memorialized in many blues and folk songs.[2] Most of the 50,000 victims were poor men, often alcoholics and minorities, so society – and regulators – looked the other way. “The Jake-leg story is almost completely about class,” Dr. Morgan told a writer.[3] “If someone had poisoned the Canadian source of bonded Scotch, something would have been done.”
As ever more medical devices, pharmaceuticals, and foods are recalled or deemed risky, we should heed Dr. Morgan's words. When an agency is charged with ensuring the safety of what people ingest, it cannot be compromised by ideology, conflicts of interest, predisposition to favor or disfavor certain entities or individuals, or blind trust in manufacturers. Unfortunately, we have witnessed these failings at the FDA and other agencies.
Physicians must be the canaries in the coal mine. In 1930, 50,000 people became paralyzed, but few physicians expressed concern. In 1962, largely due to FDA physician Frances Kelsey, MD, thalidomide was banned, saving American women from the severe birth defects that affected Europe after the drug was approved there.[4]
American physicians must be watchful, especially with new products. They must monitor patients for adverse reactions and report those reactions to authorities. If those authorities fail to respond, physicians must keep raising the alarm until someone listens. In this, physicians are our first line of defense.
I am Emily Friedman, an independent health policy and ethics analyst, and that's my opinion.
Footnotes
Reader Comments on: “Jake Leg,” Other Poisonings, Physicians as Canaries, and the FDA See reader comments on this article and provide your own.
Readers are encouraged to respond to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine, for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: glundberg@medscape.net
References
- 1.Morgan JP. The Jamaica ginger paralysis. JAMA. 1982;248:1864–1867. [PubMed] [Google Scholar]
- 2.Jake Leg Blues. Jass Records. 1977 J-CD-642. [Google Scholar]
- 3.Baum D. Jake leg: how the blues diagnosed a medical mystery. The New Yorker. pp. 50–57. September 15, 2003.
- 4.Friedman E. Happy tails, Jake leg, and the Food and Drug Administration. Hospitals & Health Networks OnLine August 7, 2007. Available at: http://members.aol.com/emilyafriedman/columns/2007-08-happy-tails.html Accessed April 21, 2008.