<scp>N</scp> ascher's Conflict with the <scp>A</scp> merican <scp>M</scp> edical <scp>A</scp> ssociation

Ignace Nascher is one of the founding fathers of geriatrics. He coined the term “geriatrics” in 1909,1 wrote one of the first modern textbooks on geriatrics,2 and made early observations on a syndrome he described as cachexia or senile debility, which has striking similarities to the current notion of frailty.3 Less well known is his dispute with the American Medical Association (AMA) with regard to the introduction of amorphous phosphorous. This had been used to prevent the manifestations of arterial aging. The AMA felt the evidence was insufficient to support its adoption and criticized Nascher's conduct in recommending its use: “Now, however, comes Dr. I. L. Nascher and introduces amorphous phosphorus as a remedy of remarkable value for the arteriosclerosis of old age. The method of introduction is somewhat peculiar. The treatment seems first to have been brought to notice through a printed slip sent to medical journals generally.”4 They go on to note that there was no evidence to support its use in animal or human studies and a lack of pharmacological data on its chemical properties. Although Nascher records no experiments on animals, which is much to be regretted, he did experiment on himself and says: “Ten grains produced a frontal headache, restlessness, excessive mental stimulation, ideas arising with such vividness as to appear as actual occurrences. There was a sense of weight or oppression in the stomach and priapism, the latter probably psychic, as I was looking for such a result. These symptoms passed away in a few hours.” Without doubt his explanations of the priapism can be applied to the whole experience; whatever symptoms there were, they were unquestionably psychic.4 The commercialization of amorphous phosphate was then criticized; most specifically, Nascher's apparent support for its use in advertisements, one of which was reprinted and stated: “Made under the direction of Dr. I. L. Nascher, New York.”4 Finally, they express concern about its use as a remedy for sexual impotence and mental decay: “Like so many products with a similar history, the unearned reputation it obtained from medical men survived in the minds of the laity, and, as is always the case, the survival has been taken advantage of by quacks. Among charlatans and nostrum makers phosphorus is still in vogue. ‘Weak men's specialists’ and venders of ‘lost manhood’ and alleged aphrodisiac drugs ‘play up’ the phosphorus fallacy for all it is worth.”4 Nascher responded in a letter5 denying any role in commercializing, marketing, manufacturing, or selling amorphous phosphorus. He stated that he was unable to find laboratory specialists willing to study amorphous phosphorus. He then goes on to state that he was only advancing a theory, not proving its efficacy: “As for the theory I advanced, it is simply a theory based on reasoning without facts to prove it. If I had facts to prove it, it would no longer be a theory or open for discussion. Being a theory, it is the province of the wise man to ridicule it and call it absurd.” He adds: “When medical science has so far progressed that the physician will be able put his tag on the molecule of drug substance and follow it through the various metabolic processes to its final elimination we will not need any Council on Pharmacy and Chemistry to decry what it cannot understand. Let me say here that scientific criticism does not stoop to ridicule for ridicule is usually based on animus or bias.” He ends his letter: “I have faith in its therapeutic value and believe competent clinical observers will have favorable results from it in suitable cases.”5 The AMA subsequently replied5 with a reiteration of their initial critiques and ended their reply: “The only conclusions that can be reached from his reply coincide closely with the very statement made by The Journal, and which we here reiterate: ‘It seems evident, therefore, that his claims for the value of this remedy rest on no better foundation than an unproved theory without experimental basis.’” A century later, the questions raised in this exchange of letters are still with us. Concern about commercialization of research, physician interaction with the pharmaceutical industry, the role of evidence in clinical decision-making, the interaction between clinicians and researchers, the use of sexual stimulants, and the use of pharmaceuticals to delay the effects of aging remain topics of lively discussion today. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author Contributions: Philip St. John is responsible for the entire content of this paper. Sponsor's Role: None.

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