Systemic Hypertension and Mitral Valve Disease.

almost incredulous envy in countries where such addiction is still a serious problem. These measures have been wholly salutary, but future legislation concerning the safety of drugs is bound to be more difficult, because no drug is ever entirely safe and its safety must be related to the purpose for which it is to be used. For example, a high degree of toxicity might be tolerated if a drug cured or stayed the progress of an otherwise fatal disease, but no significant toxicity would be permissible in a drug used for a trivial condition or if it was shown to be worthless. This brings up the whole question of efficacy and of relative efficacy; and who is going to dogmatize on this ? Again, who is going to say that the occasional fatal toxic reactions which may result, for instance, from the use of psychotrophic drugs in depressive illnesses are or are not greater than the danger of an increased incidence of suicide if such drugs are forbidden? Doubtless a committee of experts will advise the appropriate Ministers, and if experts are occasionally wrong they are less often wrong than non-experts. Nevertheless, we interfere with the prescribing doctor's final freedom of decision at our peril in a free democracy. It is easy to set up a sort of pontifical therapeutic Establishment ; but Establishments-Aristotle and Galen, for instance-have not always been in the van of progress.