M e d i c i n e A v e n u e The Cuent (Warner-Chilcott) asked the Agency (Sudler & Hennessey) for an ad that would revive interest in Mandelamine, still an effective urinary antiseptic, even with the advent of antibiotics. The Copywriter (Mel Altshuler) and illustrator (Arthur Lidov) created the most controversial ad in pharmaceutical history. (1953) ‘Silent* Pyelonephritis: Asymptomatic and Unrecognized Ante Mortem— Discovered in 6 to 20% of All Cases at Autopsy. ‘Chronic* Pyelonephritis: Despite Therapy, Still the Cause of Death in at Least 5% of All Cases at Autopsy. I he imrcnt l/tcramre * to Ihr athtmalitr to all iHfcr qurslhm*. At makers of Mjp.dc!amine (mcthen- aminc mandclate) and four other urinary tract agents, W amer-Chikott is in continuous communication with the profession on urinary infcction- W< arc aware that urinary infections are second in incidence only to respiratory infections, and that this incidence increases year to year. And we arc aw are that, although the past decade has opened doors to the fundamental nature of pyelonephritis. even the general outline of these discoveries has not been broadly communicated. The material pretested In these pates h what wc at Vtarwer-CTuleott Loos* about the «se of ooe of our products in the light of recent research. b the discrepancy so great between the incidence of pyelonephritis found pou mortrm and the incidence recognized and treated ante mortrm? J. P. Sanford wrote in J.A.M.A.: "Pyelonephritis has been found in 6 to 20% of autopsics; yet the clinical diagnosis ...w as made in only about ooc-fifth of these cases. This...suggests a high incidence of...pyelonephritis in the general population." despite rigorous antibacterial treatment does pyelonephritis so often progress from recurrence to recurrence to chronic end-stage pyelonephritis, with its inevitable foreshortening of life? Can it be that today's antibacterial* ate inadequate? Can it be th3t. if adequate, they are improperly used? Can it be that our understanding of pyelonephritis b inadequate? THE 1ST STEP The Disease-Continuum Concept of Pyelonephritis Pycloncphritb has a "natural history'' which reaches back in the personal medical hbtory of the patient - back, perhaps, to some of the undiagnosed, unexplained fevers of childhood. The pari decade has. seen three giant step* toward the understanding of urinary infections- particularly (he enigma of pyelonephritis. 48
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