The Medical Publicity Racket

Advertising and publicity are the life-blood of medical practice, as of any other enterprise in a large community. For they are the only ways that the public who need medical care can become cognizant of the physician who wishes to render it.

In a small community, word of mouth advertising suffices. But in larger communities where the individual is as lost as a needle in a haystack, other methods are required. The doctors who are denied their use can be stifled and destroyed. It is for the purpose of destroying competition that the bosses and overlords of the Eastern States have tabooed advertising for everyone except themselves by their hypocritical commercial "code of ethics."

No man was in a better position than "Doc" Simmons to realize the vital importance of advertising in medicine. He had gained his fortune and position through lurid and fraudulent quack medical advertising. A monopolistic control of all methods of advertising and publicity in medicine as a source of revenue and as a device for the control of the profession, and of politics, was almost instinctive with Simmons. No effort was spared by him or his gang to attain it.

Like Simmons, Fishbein is acutely conscious of the value of publicity. In his Fads and Quackery in Healing he tells of noted surgeons who owed their practises to persistent publicity He concludes:

"A great clinic, if properly organized, must have its publicity department"

METHODS OF MEDICAL ADVERTISING

There are a number of indirect and underhanded methods of advertising and publicity that are permissible to the physician even in sections which taboo direct advertising. They are especially valuable if they are exclusive; and where competition is keen, when they cast aspersions on competitors.

Direct word of mouth publicity and recommendation are very effective in building up a practice. Some physicians have highly developed this method. They hire boosters and widen their social contacts by joining any and every organization that will serve the purpose.

An amusing variation of this method was employed by a New York East Sider when he launched himself into practice. He hired unemployed actors and attractive actresses to ride up to his office in swank cars and sit in his waiting room for hours in order to make neighbors believe that his services were in demand by their betters. The ruse succeeded in building for him a large and lucrative practise

Affiliations with social service groups are particularly valuable business-getters, especially if the organizations maintain clinics. They solicit inquiries from the public; and direct the inquirers to their affiliated physicians. They also get extensive free advertising and publicity which nets patients.

Hospitals and clinics are the most effective and the most eagerly sought methods of advertising a physician. They are obvious advertisements that lure the patients. Their value is enhanced when they have large and rich boards of directors and subscribing memberships. Their value is superlative when they refer inquiring patients to the doctors who monopolize their facilities. And to physicians who gain control of services and the power of appointment of subordinate physicians they are veritable gold mines; for they make it possible to force colleagues who seek the hospital facilities for their patients to consult the "chief" and refer cases. The advertising value of hospitals is often enhanced by clever work of publicity men, as in the case of the Eye Institute of the Columbia-Presbyterian Medical Center and the King of Siam.

Medical Information Bureaus, such as that of the New York Academy of Medicine, are organized by influential physicians to solicit public inquiries about doctors and medical topics. The inquirers are directed to the offices of the sponsoring physicians. They are effective in building up the reputations and high-priced practices of the sponsors, and in slandering and destroying the reputations of competitors. In the latter they are generally cautious and only dole out their slander in the absence of witnesses, to avoid legal entanglements.

Popular lectures and publications are a direct form of contact with the public. Columns and signed articles in the lay press and popular books are more effective than lectures and radio talks.

Scientific lectures and publication are publicity to colleagues who may refer cases. Their value is greatly enhanced when they are made the basis of popular publicity reports in the lay press. Medical discovery is a justifiable but rare basis for these forms of publicity.

Control of institutions of medical education and professorships and teaching positions in them are forms of advertisement that often net high returns in consultations and in repute gained. These consequently are avidly sought, even when they carry no direct emolument.

When Simmons and his A.M.A. gang undertook to gain complete and monopolistic control of all these forms of advertising and publicity to insure greatest profits by elimination of competition, they met with the resistance of some powerfully entrenched groups. With these they compromised whenever it was found advantageous to do so.

ETHCIAL DOCTORS MAY NOT ADVERTISE—

Samples of cards that are given to clinic patients of New York City to advertise their doctors. [see below] The two lowest cards leave no margin for error, but carry both the names and addresses of the doctors. This is a very superior and concentrated form of advertising directly to persons who urgently require the services offered. These advertisements must be preserved by the patients if they wish to avoid the penalty imposed by the clinic for their loss. There is no element of 'hit or miss' about these advertisements. They are tantamount to straight-forward orders to the patients.

"Come to our private offices if you want adequate services and if you can afford to pay Our fees." The doctors of many of these institutions establish their offices in the immediate neighborhood of the clinics.

The cards of eye, ear, nose and throat clinics were selected because these specialties are particularly mercilessly commercialized. Many of the hospitals are openly operated as business agencies of the members of the staff and no charitable services other than those dictated by law are rendered. Thus the Manhattan Eye and Ear Hospital reported for 1932 a profit of about forty thousand dollars on glasses provided its 'charity' clinic patients. Staff membership in many of these hospitals constitutes a lucrative business monopoly which the hospital groups jealously guard. THIS IS A PERFECT DEMONSTRATION OF THE SHAM AND HYPOCRISY OF "MEDICAL ETHICS".

JOURNAL OF THE A.M.A.—THE PAYOFF

Control of several phases of publicity and advertising was gained by expansion of the publication activities of the A.M.A. and by the elimination of competing publications. The weaker journals were destroyed and the strong ones were merged. Publishers have been barred, for instance, from advertising or displaying their magazines competing with A.M.A. journals in their exhibits at A.M.A. conventions.

The methods which Simmons and his crew used in their battle for a monopoly of medical publication and of advertising to the profession were often crude and illegitimate. In any other business their use would have precipitated prosecution by law enforcement authorities; but medicine is regarded by the layman with unholy awe, as a mystery beyond his ken.

Pressure was brought to bear on non-members by all the powers and agencies which the Association controlled, to force them to join. If they refused they were slandered, libeled and their reputations undermined. Fishbein, like Simmons, has left himself free to use these tactics by transferring his property to his wife and maintaining himself judgment-proof. Non-members usually are barred from publication in the A.M.A. journals.

Members of the Association were forced to subscribe to the Journal of the A.M.A. or to some of its other publications, at a high annual cost that yielded a splendid profit. If they wrote for competing publications, they were threatened with expulsion; but if they sent their articles to the Journal, they were generally refused publication. For it never has been medical importance of the article that determines its publication, so much as the political rank of the contributor. Discovery and publication are regarded by the clique solely in the light of its advertising and commercial advantage. And hi-jacking of a discovery, or its suppression and conversion into the secret private remedy of a clique, on the pretext of a "clinical trial," is commonplace. Rarely does a medical discovery receive publication in the Journal of the A.M.A. before it is antique.

Advertisers are similarly treated by the A.M.A. gang. Their products may not be advertised in any journal owned or influenced by the A.M.A. unless "accepted." Since this group includes most of the important popular magazines, the rejected product may be virtually barred from the market. Products do not remain "accepted" unless the sponsors are prepared to spend considerable money on advertising in the group of medical journals owned or controlled by the A.M.A. This prescribed group and the expense of advertising in it, have grown considerably since the organization of the Cooperative Medical Advertising Bureau, which represents a large number of State Medical Society journals. Firms that reduce their advertising or refuse to advertise as much as required, find the "acceptance" of their products withdrawn. The A.M.A. has openly threatened firms that advertise in media other than its own journals with withdrawal of "acceptance" of their products. That such a conspiracy in restraint of trade and its potentialities for extortion should be permitted to exist, is unprecedented in our legal annals. But it is all done sanctimoniously under the cloak of "protecting the public."

DEPRESSION PROFITS

When the depression came along, and profits and revenue of the A.M.A. journals were threatened, the group was in excellent position to protect and to enhance its profits. There was no danger of loss of advertising accounts. The cost of production of the Journal of the A.M.A. dropped and the profits rose proportionately. But the subscription price exacted from the hard-hit physicians for the Journal was raised from five to eight dollars a year. At the same time the Association made an attack on some enterprising publications which were launched as advertising promotions and distributed reliable news of medical advance to the profession free of any charge. Editorially Fishbein thundered "Beware of the Greeks bearing gifts." But the A.M.A. subscriptions fell, and the free publications were the only means of keeping abreast of medical advance for a large proportion of the profession.

When the State Medical Societies and the A.M.A. gained control of distribution of Relief to the medical profession, they were in position to coerce back on their membership and subscription list the physicians who required Relief. They were generally led to believe that they must—or else—

Under these circumstances, it is not surprising that the Journal of the A.M.A. was one of the most profitable magazines in the country in the midst of depression, despite the oft crushing poverty of its readers. In 1938, the Journal reported a gross earning of $1,650,000 and a net profit of $670,000; and its surplus was almost four million dollars.

If the A.M.A. and its Journal really belonged to its members, instead of a ruling clique, it might undertake to fulfill the pretended function of the Association, to broadcast knowledge of medical advance to the entire profession. It would then find that by distributing the Journal gratis to the entire profession, instead of making it a means of extortion, the advertising revenue that would be derived from the larger circulation would yield even larger profits. But the gang in control act on the idea "You spoil the sucker if you give him a break."

ADVERTISING AND "ETHICS"

To muzzle the rank and file of the profession and to give the bosses of organized medicine a monopoly of medical business and of advertising and publicity, the A.M.A. designed its "code of ethics." This code made it a violation to speak or write for publication without the permission, censorship and approval of the bosses and overlords. Whatever the latter might do on their own initiative, however, was designated as "ethical." The principle underlying the code is: "The king can do no wrong."

The dual character of this commercialist "code of ethics" and the manner in which it boosts the business of the merchants-in-medicine who boss the Association is evident in the most recent decree regarding medical advertising and publicity which was published in an editorial in the New York State Journal of Medicine of August 15, 1929 (pp. 1021 to 1022). It reads:

"Medical publicity is that which is educational and deals with the medical profession in its entirety.

"Medical advertising appertains to medical publicity which deals with the individual and may be used to his or her personal advantage."

Regarding publicity, it proceeds to say:

"Physicians throughout the nation have evolved a standard method of popular education as follows:

"1. The unit should be the County Medical Society. "2. Medical education work shall be done by committees composed of physicians who are specialists as writers, speakers, organizers and general medical leaders.

"3. The names of these specialists should be kept prominently before the public in order that popular education may be a concrete, present reality, instead of a far-off abstraction for which no one is responsible."

The gist of this "standard method" is that the "medical leaders" or bosses authorize themselves exclusively to keep their names prominently before the public in the press, the radio and in all other avenues of publication. This hypocrisy of the medical boss in his own traffic is characteristic of the clan.

The grumbling acceptance of these hypocritical dicta by the rank and file of the profession illustrates aptly their lack of spirit and degeneration. They do not dare attack their bosses when they belie the proverb "What is sauce for the goose is sauce for the gander," however strong may be their resentment. But if one of their own number receives the barest publicity mention merited by significant discovery, ferocious jealousy is aroused and his reputation suffers. Prominent in the ranks of the slanderers will be found the self-advertising, self-publicizing "leaders" themselves; they jealously guard the privilege which dishonestly they have usurped.

In the West, where a certain measure of straight-forwardness still persists in medical organizations, the hypocrytic "ethics" regarding advertising does not apply. Anyone may advertise in the newspapers. Even in the East, the New York State Medical Society permits foreign-born physicians to advertise in the foreign language press, because "leaders" do not compete for the poorly-paid practice among the foreign element and their commercial interests are not impaired.

How well advertising has served to build up the reputation and business of "leaders" of higher caliber than "Doc" Simmons is illustrated by the Mayo Brothers. When they arrived at Rochester, before either of them had had any experience worth mentioning, they caused to be distributed handbills which modestly stated that they were the leading and ablest surgeons in the country. They were master hands at self-advertisement; and fortunately their ability caught up with their advertising.

TRUESDALE AND THE "UP-SIDE-DOWN STOMACH"

The selectivity of the publicity accorded to the bosses of medicine is illustrated in the case of the Truesdale Hospital, the medical director of which is Dr. Philemon E. Truesdale, who stands high in the circles of the A.M.A. and the American College of Surgeons. The business of the hospital suffered during the depression. That was not regarded as "ethical." Consequently, with no protest from the American College of Surgeons, a world-wide newspaper publicity campaign was launched in the press, centering upon a child who suffered from a not-uncommon ailment, diaphragmatic hernia, which is popularly described as "upside-down stomach."

There was nothing new or extraordinary about the operation performed on the child to correct the hernia. The only special phase of the case was the boost to the business of the hospital and its politically influential surgeon. The executive officer of the Medical Information Bureau of the New York Academy of Medicine, Dr. Galdston (ne Goldstein), himself acted as publicity and advertising agent for the hospital and surgeon, and scooped the press with detailed accounts of the operation and of all the incidental publicity maneuvers. It is not known whether, or how much, the publicity agent was paid for this business-getting stunt.

"LEADERS" AND "ETHICAL" PUBLICITY

Another striking example is Dr. K_____ S_____, a prominent medical politician who has succeeded in making politics serve him to carve out a spurious reputation as a scientist. He is a member of a censorship committee. At an annual convention he was introduced by Morris Fishbein to one of the members of the Science Writers' Association, with an urgent appeal that he be given a write-up. In the interview, he pronounced himself to be the greatest man in his field and falsely laid claim to the discovery of a condition which had been brought to light a century prior and had been the object of research and discovery of numerous investigators in the intervening period. The interview published was an accurate report of the statements of this "scientist."

Immediately after the publication of this interview, the editor in question was besieged by the censor of the Academy of Medicine, on the publicity committee of which this "scientist" was the moving spirit, with the object of inducing him to furnish the interviewed "authority" with a written statement falsely asserting that the interview had not taken place. The reason for the request was that the "scientist" had been assailed and ridiculed by the members of his organization and his political influence endangered. The editor furnished the requested statement.

MEDICAL "LEADER" AND "ETHICAL" TESTIMONIALS

A glaring instance of the vicious duplicity of the ethics of medical advertising is the case of Dr. William Allen Pusey, former president of the American Medical Association and editor of one of its magazines. Dr. Pusey entered into direct competition with the testimonial business of the American Medical Association and its Council on Pharmacy and Chemistry, by selling to Proctor and Gamble, manufacturers of soap, his personal testimonial for Camay Soap. In this testimonial, which appeared in numerous magazines throughout the country as the backbone of an intensive advertising campaign, Dr. Pusey certified that "Camay Soap is much more than the best soap for your complexion." This statement was obviously false for some of the readers of the advertisement, for dry skins should have different soaps than oily skins.

In spite of the obvious falsity of the testimonial, these advertisements evoked not the slightest protest from the Association or from its timid vassals, the rank and file of the profession. The only rebuke administered to Dr. Pusey was one which I sarcastically interposed in a discussion of remarks made by him before the New York County Medical Society. He did not undertake to reply.

MEDICAL SERF AND "UNETHICAL" TESTIMONIALS

In sharp contrast with the case of Dr. William Allen Pusey's testimonial was that of Dr. Shirley Wynne, Commissioner of Health of New York City. Dr. Wynne, at about the same time, expressed his approval of dental hygiene for quotation in an advertisement of a dental cream. However prominent he was in civic politics, Commissioner Wynne did not rank as a medical politician and was not among the local hierarchy of the Association. Though his testimonial was truthful and honest, and thoroughly justifiable, in contrast with the above-mentioned, like a pack a jackals the New York County Medical Society who had quavered before the more puissant Pusey, preferred charges against Dr. Wynne for his testimonial and forced him to resign from its membership to avoid further annoyance in the matter.

The moral of the story is obvious: "Testimonials are 'unethical' unless payment for them is made to the American Medical Association or its officers." The dishonesty and insincerity of the Association in this matter assume the proportions of a farce.

MULTIPLICATION OF SOCIETIES AN ADVERTISING DEVICE

For the primary purpose of intensifying and multiplying the opportunities of self publicity and advertising, medical "leaders" have organized a multitude of new national and specialty associations. An excellent illustration is the American Academy of Ophthalmology and Otolaryngology. It is dominated by the same clique that controls the corresponding sections of the American Medical Association and of the American Association for the Advancement of Science, and also the two dozen or more societies in this field, who peddle the same trite papers and exhibits from one to the other, often without altering a comma. The presentation of papers is limited to the clique year after year; and it is doubtful if one of them has had a new idea in decades. The principal purposes of the organization and its officers is to drum up business among physicians from small towns and backwoods for themselves and their post-graduate teaching businesses; and above all else, to secure for themselves publicity build-ups in the lay press.

Publicity is divided among the clique on a pre-arranged basis. Before the bosses of the organization would consent to hold its annual meeting in New York City, in 1936, the New York members were forced to agree that they would not "hog the publicity," i.e., that they would stay in the background and permit the clique spielers from the hinterland to cover themselves with publicity and glory.

How crude are the publicity methods of this Academy can be appreciated by the study of the plan whereby the doctors from the sticks and backwoods, and the subordinate "junior members" are compelled to pay for the advertising and publicizing of the clique by the purchase of tickets to lecture courses the contents of which can be found in any of the older textbooks.

Even the annual dinners are conceived as the crudest forms of advertising for the clique bosses. This is illustrated by the following "theme song" of the Boston Convention of the Academy in 1933:

"ALL ARE WET!

(Sung to the tune of "Alauette," in honor of Past President McKee of Montreal, at 4:00 A.M. on Mount Royal.)

All are wet, oh, very, very wet! oh, All are wet, oh, see them all at play! Have a drink with Burt Shurly!! Have a drink with Burt Shurly! Have a drink with Han McKee! Have a drink with Han McKee! Here's a toast to Mosher, too! Here's a toast to Mosher, too! Wilder doesn't mind a few! Wilder doesn't mind a few! Put no booze at Barnhill's plate! Put no booze at Barnhill's plate! Don't let Greenwood's drink be late! Don't let Greenwood's drink be late! Secord Large laps up the dough! Secord Large laps up the dough! Beer for Beck! he loves it so! Beer for Beck! he loves it so! Oh Shurly! (twice) Oh McKee! (twice) Mosher too! (twice) Oh Shurly! (twice) Oh McKee! (twice) Wilder, few! (twice) Mosher too! (twice) Oh Shurly! (twice) Oh McKee! Oh McKee! All are wet! Oh! All are wet! Oh! Barnhill, no! (twice) Wilder, few! (twice) Mosher too! (twice) Oh Shurly! (twice) Oh McKee! (twice) All are wetl Oh! All are wet! Oh! Greenwood yes! (twice) Barnhill, no! (twice) Wilder, few! (twice) Mosher too! (twice) Oh Shurly! (twice) Oh McKee! (twice) All are wet! Oh! All are wet! Oh! Large lies low! (twice) Greenwood yes! (twice) Barnhill no! (twice) Wilder, few! (twice) Mosher too! (twice) Oh Shurly! (twice) Oh, McKee! (twice) All are wet! Ah! All are wet! Ah!

Those named are former presidents and bosses of the Academy.

The presentation of papers on medical discoveries by the rank and file membership of the Academy is rigidly barred. It would detract from the hyper-intensive advertisement of the dominant clique.

In the decade since the first edition of this volume was first published, the monopoly of medical publication, and of the advertising and publicity which it implies, has become so intensified as to be absolute. It rivals the "thought control" of other dictatorships, and has reached the point that Waldemar Kaempffert reported from the Chicago convention of the A.M.A., in the New York Times of June 27, 1948, as follows:

"As for the scores of papers that were read, they told the specialists little they did not already know . . . Probably most of the physicians and surgeons in attendance learned more from the manufacturers exhibits on Navy Pier than from the papers that were presented."

This report is an expression of the airtight censorship on medical discovery emanating from the rank and file of the profession and the suppression of medical advance. The same state has been brought about by medical politicians and merchants in every scientific organization. They have brought all of them under their control, including the medical section of the American Association for the Advancement of Science. They have completely suppressed the presentation of any original advances in medical science and have limited programs to so-called "symposia" which are nothing more than rehashes of older textbooks that are generally prepared by "ghosts" for the self advertisement of medical Babbitts.

In an effort to remedy this situation, the author launched the Science Bulletin prior to the War. He was forced to discontinue it because of lack of paper. Plans are under way to resume the publication for the purpose of giving discoverers a medium for publication to establish priority of discovery and stop the systematic theft of ideas and discoveries.