Appraisal of New Drugs

To the Editor:— Dr. Russek's reply to my criticism of his method for studying coronary vasodilators (The Journal, May 21, page 216) shows misconceptions and misunderstandings needing rebuttal. It is to be expected that any advocate of a specific test method is somewhat hesitant to admit the shortcomings of his technique, and I, and presumably Dr. Russek, am no exception to this. However, Dr. Russek raises several questions that transcend the problems of evaluating coronary vasodilators and that involve not only appraisal of drugs indicated for relief of subjective complaints but also clinical testing in general. The investigator of new medications uses pharmacological data obtained from animal studies indicative of toxicity, effects on a particular system, and clues for possible clinical usefulness. Clinical testing includes (1) studies designed to demonstrate in man a pharmacological effect confirmatory of animal experiments, (2) an evaluation of the comparative effectiveness and safety of the