While an investigation was being made into the mortality rates, there was also a review of the laboratory procedures being carried out. For this purpose the medical division called in the foremost experts in the field, Dr. Otto Folin and Dr. Stanley Benedict. These men devised new quantitative tests for glycosuria and albuminuria, which became standard procedure in medicine. In addition, the laboratory refined and improved methods of analysis of various substances in the blood. Dr. Folin developed a method of determining accurately the amount of sugar in a very small quantity of blood.

This method was eventually used in medical laboratories all over the world. Another interesting development was the use of x-ray procedures in solving medical problems of policies such as “life insurance quote without medical.” This revolved primarily around the use of the fluoroscope, an x-ray device through which the physician can “see” instantly the internal structures of the body. Fluoroscopy was first taken up by the medical division as an efficient and inexpensive method of detecting early tuberculosis in applicants for employment and in company employees at the home office.

Studies of various abnormalities of the lungs disclosed in these examinations helped the company’s doctors to determine their significance, and as a result some abnormalities, such as healed childhood tuberculosis, were proved to have no adverse effect on longevity. Insurance practices were consequently revised in the light of these findings. X-ray films were also extensively used in examinations of the heart and lungs. The determination of the nature and extent of cardiac enlargement by the usual methods of examination was, in some respects, a “rule of thumb” affair.

An x-ray film of the chest, however, yielded more accurate information on the size of the heart and often disclosed other valuable details regarding that organ. Consequently its use, when a heart abnormality was present or suspected, resulted in providing a more accurate and fairer judgment than would otherwise have been possible. Here again observations on home office employees giving different types of life insurance quotes expedited the development of standards for insurance and general use. The investigation of heart impairments had special interest for those concerned with medical selection in the Metropolitan.

In 1899 the company began to insure persons with certain types of heart murmurs, issuing policies in the special class branch to these applicants. As there was no mortality experience to go by, the decision to accept such risks was made on the basis of clinical judgment. In the aggregate, the mortality experience on these heart cases proved to be within the expected limits. Periodic studies proved, however, that some types of heart murmurs were insignificant abnormalities, while others were of such seriousness that persons so impaired were not insurable at all. New procedures that followed for diagnosing heart disease were also useful in insurance medicine.

One of the most important of these was electrocardiography, which was of prime value in detecting diseases of the heart muscle. Prior to the use of this technique in insurance examinations (for life insurance rates and quotes) little distinction could be made with respect to applicants with such disorders. The development of electrocardiography, however, made it possible to identify some cases of serious heart disease that would not ordinarily be picked up by the usual physical examination.

While the normal pattern of the electrocardiogram was defined in broad outlines, there were numerous deviations the nature and significance of which were obscure for many years to follow. In the accumulation of data for the solution of these problems the insurance companies, and particularly the Metropolitan, laid foundations for future scientific advances which would prove of great value not only in insurance medicine but also in general practice.

Until 1961, Japanese Public Law 39 declared that a man under the influence of alcohol was “temporarily of unsound mind” and could not be held legally responsible for anything he did when drunk. Japanese men, so proper and polite when sober, could when drunk commit mischief and mayhem they would normally consider unspeakable – including crimes as serious as murder – without fear of arrest, lawsuits or jail time. No one, including habitual alcoholic offenders, was ordered into alcohol rehab, because getting drunk was more or less a man’s god-given right.

Public Law 39, dating from 1907, was amended in 1961 to declare that drunks were henceforth indeed responsible for their actions. We might think this a little late compared to the laws regarding alcohol abuse here and in much of the rest of the world. But Japan’s culture was its own, and goodness knows how many barbaric American customs give the Japanese the willies.

But it was estimated that before the law changed, as many as 10 murderers a year went unpunished – not to mention all the wife-beatings, injuries to others, and damage to private property. Perpetrators who committed crimes while under the influence of alcohol weren’t jailed and ordered into alcohol rehab programs –drug and alcohol rehab was not widely known at the time. However, a stern lecture to amend one’s behavior was often administered by a policeman or other official.

Back in the 1950s and early 1960s, there were stories going around about how some Japanese police, forced to gently detain a drunk overnight because he was just too far gone to be safely left out in public, would tape record his loud and abusive behavior. The next morning, the cops would play the tape back to him – and to his irate wife if she came to pick him up. The theory was that the abusive shouts, threats, rude language and drunken behavior were so shameful that the man would think twice about getting publicly drunk and abusive again.

It wasn’t exactly alcohol rehab, but perhaps it was effective for the culture at the time. Disturbing the peace – or the “wa” as it is called in Japan, more akin to “harmony” – is something the Japanese were acutely uncomfortable with.

A half-century has passed since the new law was adopted in Japan, a law similar to the law in America that holds drug and alcohol abusers legally responsible for their acts while under the influence. Yet look at the situation: alcohol abuse in all the drinking countries of the world continues to cost society untold billions in social costs, damaged families and lost lives. The need for drug and alcohol rehab continues to outstrip the availability of drug and alcohol rehab programs.

Punishing alcohol abusers with jail time and fines for their drunken crimes is all well and good. But people who cannot control their drinking or themselves when they have been drinking need alcohol rehab. The Japanese had it at least partly right – people under the influence of alcohol are “temporarily of unsound mind.” Only a thorough and complete alcohol rehab program can handle the real reasons behind why someone feels the need to do that to their mind in spite of the often horrific consequences.

Reps. John D. Dingell (D-MI 15), Frank Pallone, Jr. (D-NJ 06) and Bart Stupak (D-MI 01) introduced the <a href=”http://www.fda.gov/” rel=”nofollow”>Food and Drug Administration Globalization Act of 2009 (H.R.759). This legislation is beginning for Congress’ efforts to address several real threats that substandard and counterfeit drugs pose to the pharmaceutical supply chain.

The bill inlcudes a number of the Partnership for Safe Medicines’ Principles for Drug Safety and also introduces a Quality Risk Management Plan, which outlines specifications for safeguarding drug and medical devices, including:

* An assessment of companies contracting with a person to supply raw materials or ingredients;

* Monitoring and review through periodic on-site audits of the production facility’s conditions its controls and practices;

* Monitoring incoming materials; and

* Implementation of systems to ensure the appropriate specifications, test methods and verification of the drug ingredients’ identity, quality, strength, and purity.

The proposal also asks for authority to implement stronger enforcement tools, including:

* Destruction of counterfeit imports if they pose a risk of injury or death;

* Monetary and criminal penalties against offenders;

* Mandating the FDA to recall and detain unsafe drugs; and

* Allowing the FDA to subpoena records related to possible violations.

These types of proposals are fantastic first steps towards a safer drug supply. It is our hope that these proposed changes will help address the counterfeit drug and online pharmacy issues threatening the safety of our drug distribution system. They may also signal a beginning of a systematic vigilance to ensure continuous assessment and safety of the drug supply. For more information on the threat of substandard and counterfeit drugs, visit www.safemedicines.org.