Testimonials for a Price

THE A.M.A. "ACCEPTANCE" OF FOODS AND DRUGS

A highly lucrative phase of medical business is the drug industry. "Doc" Simmons fashioned the entire structure of the A.M.A. to the purpose of gaining a whip-hand over the profitable trade. The Journal of the A.M.A., the publication, publicity and advertising rackets, and the censorship of the press were all designed with an eye to it.

COUNCIL ON PHARMACY AND CHEMISTRY

The device that served to gain the A.M.A. a direct control of the drug trade was the Council on Pharmacy and Chemistry and its "Acceptance of Food and Drugs." Ostensibly it was set up for the purpose of investigating and certifying the quality of drugs to the medical profession and to the public. Its activities are virtually the issuance of super-testimonials for the manufacturers. Later other Councils were set up to pass on foods and other items.

By a series of maneuvers this testimonial business was converted into a strangle hold on the drug trade. The "code of ethics" was amended to bar physicians from issuing testimonials, so as to give the Council a complete monopoly of this business. Advertising in the columns of the A.M.A. Journals was barred to products which are not "accepted." Competitive medical journals were driven out of business and the pressure which the A.M.A. could put on drug manufacturers was tremendously increased.

Later the A.M.A. conspired with the publishers of lay newspapers and magazines to bar the advertising of any product that is not "accepted." (The Better Business Bureaus participated in this, serving the interests of the A.M.A.) It thereby established one of the few monopolies in restraint of trade which has not been molested during the past three decades. This laid the foundation for an immensely profitable racket. The bulk of the money which flows into the coffers of the A.M.A., or into the pockets of its bosses, is derived directly or indirectly from this illicit control over the drug industry.

The Council on Pharmacy and Chemistry is a blind behind which the bosses of the A.M.A. act. In its ranks there are some who are distinguished scientists and others who are not. But the members of the Council have little to say about its activities. This is made quite clear by the recent resignation from the Council of the eminent scientist and Nobel prizewinner, Dr. Henry H. Dale, which he indicated was an expression of indignation at the obvious unfairness of the actions of the Council and the A.M.A. Some scientists who lend their names to dignify the Council are merely its pawns.

The "reports of the Council" are generally merely the mouthings of the bosses of the A.M.A., of the editor of its Journal and his henchmen. From the very start, the distinguished scientist and teacher Dr. Frank G. Lydston undertook a courageous campaign of reform from within the A.M.A. In a booklet entitled "Why the A.M.A. Is Going Backward" he wrote as follows:

"The achievement of which the oligarchy of the A.M.A. has boasted most vociferously has been its belated war on proprietaries, quack medicine manufacturers and impure food producers.

"When one recalls the nauseous array of proprietary fakes on the advertisements of which the oligarchy built its financial prosperity, its 'holier than thou' pose is sickening.

"It was fitting to its psychic constitution that after the . . . A.M.A. has for years done its level best to promulgate the interests, and to fatten upon, fake manufacturers and professional poisoners of the innocent, it should bite the hand that fed it.

"Despotic powers such as the oligarchy wields over the drug and food manufacturers is dangerous, and human nature being what it is, that power might be expected sooner or later to be abused."

Professor Lydston was as wise as he was courageous. Subsequent events bear out fully how sage was his judgment of the character of the men who dominated the A.M.A. when he suspected that the reform which they pretended to adopt would merely be used by them as a cloak to cover more nefarious activities.

CONSIDERATIONS FOR "ACCEPTANCE"

An amusing tale is told about the early days of the "acceptance" racket that amply supports Dr. Lydston's statements. Dr. W.C. Abbott, it is reported, became enraged at the rejection by the A.M.A. of all the products of his firm. It was threatening his ruin. Realizing that "Doc" Simmons really was the Council, Dr. Abbott sent an assistant of his to Lincoln, Nebraska, to dig up some information that might make the "Doc" more amenable to reason. The investigator brought to Abbott full evidence of all the malodorous activities of "Doc" Simmons. Dr. Abbott also secured affidavits regarding some operations performed by "Doc" Simmons in Chicago and confronted him with these data. Upon viewing it, Simmons is reported to have looked up and asked:

"What do you want?"

"I want all the products of my firm 'accepted'," Abbott is said to have replied.

It is a matter of record that the Abbott products were "accepted" by the A.M.A. thereafter.

The history of the A.M.A.'s "Seal of Acceptance," is replete with betrayals of professional and public trust. Drug products of the highest value have been rejected or their acceptance unwarrantedly delayed. Worthless, dangerous or deadly drugs and foods, have been hastily accepted. And sometimes the journals of the A.M.A. have all the more heavily advertised drugs that the Council has pronounced to be worthless.

Delayed "acceptance" or rejection of valuable drugs are responsible for much human misery and loss of life. Some such instances, which are illustrative of numerous others, will be recounted.

COD LIVER OIL REJECTED

A most ludicrous demonstration of the pretended omniscience of the A.M.A. which assumes that what they do not know or do not believe, is not true, is the case of cod liver oil. Intelligent observation interpreted by common sense, had led many generations of plain folks to realize the value of cod liver oil as a medicine for the prevention and cure of rickets and of other conditions. "Scientific" medicine propounded by the "leaders" of medicine, who were so purblind in their dogmatic ignorance that they could not see the obvious, denied any value to the "quack nostrum," cod liver oil.

In the second decade of this century, however, some intrepid European physicians, daring to tread on unsanctioned ground, undertook to evaluate the folk remedy. Verification of the value of cod liver oil in medical treatment, brought derisive editorials and attacks upon this work from the "leaders" of the American Medical Association.

By 1920, there had been completely confirmed by ponderous, dull-witted researches what many a generation of housewives had known from plain observation and common sense interpretation. The A.M.A. politicos were forced to retreat by the sheer weight of evidence. Cod liver oil was grudgingly "accepted" by the Association and its "omniscient" Council and editor.

Until then, the A.M.A. had barred the advertisement of the product to its reader-physicians and had attacked its use vigorously as a "putrid oil of no greater value than any other fatty oil." Until then, the blind trust of the public and of its medical advisers in the reliability of the Association and its Council deprived a multitude of children who were under "regular" and "scientific" medical guidance, of the benefits of cod liver oil and its vitamins.

Few people can now fail to appreciate the falseness and absurdity of the actions of the A.M.A. and its Council which denied that cod liver oil had any medicinal value. Less readily appreciated by the public are the numerous similar actions by the Association which each year bar from advertisement and public use, invaluable and life-saving drugs.

DELAYED SULPHANILAMIDE "ACCEPTANCE" FORCED

Sulphanilamide was taboo to the American Medical Association journals and their medical readers for over two years after its unique value had been recognized and broadcast in the European medical journals. Failure of "acceptance" of the drug by the A.M.A. Council served to bar its advertisement in the U.S.; and in sharp contrast with other instances which will be mentioned shortly, no mention without "acceptance" was made.

As a consequence of this act, which is characteristic of the arbitrary and monopolistic control of medical publication and medical advertising by the American Medical Association and its editor, numerous victims of the deadly disease streptococcus septicemia, popularly known as "blood-poisoning" were left to die. They died as sacrifices to medical rackets because their physicians were prevented by the Association from timely access to knowledge of the value of sulphanilamide, which alone might have saved their lives.

After a member of the Roosevelt family was successfully treated with sulphanilamide by a physician sufficiently favored by the A.M.A. to be given the knowledge and use of the drug by its American distributor, the news and information about the drug was published in every newspaper in the country. In this manner, through the newspapers, the bulk of the medical profession first became acquainted with the drug, and thousands of victims of an almost hopelessly fatal disease were given a forlorn chance to live, that the A.M.A. acceptance and advertising racket had granted previously only to a chosen few.

FISHBEIN STRIKES BACK

This incident probably upset many calculations and possibilities of profit for the inner ring of the A.M.A. It also robbed Fishbein and his associates of the opportunity to bask in the spot-light of newspaper publicity. He recaptured the opportunity by immediately issuing exaggerated warnings of danger of the drug and by an attack on the drug firm that had made the product available to the American public.

Evidence of the value of sulphanilamide was voluminous. It piled up so rapidly that Fishbein lost face in his attacks on the drug and on the house which marketed it. The A.M.A. Council on Pharmacy and Chemistry found itself forced by honest publicity to promptly "accept" the product.

This incident rankled the powers-that-be of the A.M.A. deeply. In October 1937, there appeared on the market the preparation of a solution of sulphanilamide in an extremely poisonous solvent, diethylene glycol. It was announced absolutely untruly, by the United Press with which Fishbein was identified, that the poisonous product which caused numerous deaths was Prontolyn, the Winthrop & Company trade mark for sulphanilamide. This accusation was promptly retracted when the firm of Winthrop & Company protested its falsity; but the damage to the firm that was regarded as "kicking over the traces" and breaching testimonial and advertising discipline had been inflicted with a severity designed to discourage any other manufacturers from revolting.

Subsequently, every avenue of publicity was utilized by Fishbein to broadcast that the poisonous nature of the "elixir sulphanilamide" was attributed to the glycol solvent. He did not relate, however, that a more poisonous glycol solvent had been "accepted" by the Council and the A.M.A. and introduced into medicine with their sanction as a preservative and solvent in drug preparations intended for injection into the body ("New and Non-Official Remedies", 1935, p. 132, and 1937, p. 116). Nor did he relate that current issues of the A.M.A. journals were carrying advertisements stimulating the use of these glycol bearing products. Nor did he point out that since the A.M.A. and its Council had endorsed the introduction of the glycols in medical preparations, the deaths due to the glycol solvent in elixir sulphanilamide could be blamed partly on the A.M.A. and himself. This situation may have some bearing on the reason why the Food and Drug Administration whose duty it was to warn the public and to act in this crisis, permitted Fishbein to supersede it.

This is not an isolated or rare instance of the practice of the Association and its editor of brazenly pointing the finger of accusation at others for jeopardizing human life by a procedure or preparation which it has accepted. Another such case, radium drinking water, will be related.

For subsequent "good behavior" Winthrop & Company was prominently mentioned in the November 1939 United Press reports of the granting to Dr. Domagk of a Nobel prize for the discovery of the value of sulphanilamide. The dispatch stated that the doctor had received the prize for the discovery of Winthrop's trade-marked product "Prontosil."

IODOBOR POWDER AND COMPETITORS

Another illustration of the damage done by the A.M.A. to public interest and to a drug firm by ill-motivated "rejection" of a valuable drug is the case of Iodobor powder. Iodobor powder is a bland but powerful general antiseptic, which liberates gaseous iodine that penetrates deeply on contact with the tissues. Many times as strong as carbolic acid, it is neither irritating nor poisonous, and is one of the most efficient antiseptics and germicides available.

Iobodor powder was originally marketed for use in infections of the ear and of the mastoid cavity. These infections generally cause impairment of hearing or deafness, and not infrequently jeopardize life by extension to adjoining structures. Up to the time of the introduction of Iobodor powder, the only method of treatment which offered some hope of success was operation on the mastoid process. These operations generally involve a loss of hearing, result in death in five to ten percent of the cases; and in many cases they merely check the infection temporarily.

Iobodor powder offered the first uniformly and consistently successful method of treatment of these ear and mastoid infections. It not only clears up the infection but also restores hearing in most cases. It has come slowly into widespread use throughout the world, has saved numerous lives, and has restored the hearing of thousands of victims of ear infections.

The slowness of adoption of this Iobodor therapy of ear infections was due to the A.M.A., its Council, and politics. At the very outset, Iobodor powder was submitted to the Council on Pharmacy and Chemistry for "acceptance" in order that it might be advertised to the medical profession. There was really no requirement, even on the part of the A.M.A. that this be done; for Iobodor consists of two standard antiseptics specified on the label, which have been long listed in the Pharmacopeia, mixed in a special manner. For such a product the rules of the Council provide automatic "acceptance" and access to advertising columns. The firm marketing the product sought acceptance, however, because it found its advertising flatly rejected.

When it rejected the product, the Council on Pharmacy and Chemistry published a deliberately falsified and absurd "chemical analysis" of the sample submitted, which was designed to injure the firm marketing the product. A short time thereafter there appeared in the reading columns of the Journal of the A.M.A. an article extolling the virtues of a competitive product of identical composition which later was placed on the open market as a secret proprietary remedy violating all the rules of "ethical" marketing laid down by the Council and the Association.

Investigation revealed the reason for this discrimination. A doctor, who was pushing the competitive product, owned the trade-mark and patent jointly with his chemist brother-in-law, and had undertaken, through political and other influence, to obtain rejection of the honestly marketed product which had been submitted for "acceptance." He had also arranged to secure free advertising and publicity for his own product which he then had no desire to submit to the Council; for he meant to keep secret its patented formula and under its rules the Council might have been compelled to "reject" the product. As a result of these maneuvers, the honestly marketed Iodobor powder was barred from effective advertising. Its competitor, though it was a patent medicine and considerably the more expensive, was given the monopoly of the medical market.

DANGEROUS AND WORTHLESS PRODUCTS "ACCEPTED"

Products that are proved dangerous or worthless are not necessarily rejected by the Council. Nor does the rejection of a product or its proved injuriousness bar its publicity and advertisement from the columns of the A.M.A. journals. On the contrary, many such products have been put into widespread use through the agency of the A.M.A.

In numerous instances foods and drugs "accepted" by the Council on Pharmacy and Chemistry and advertised extensively in the columns of the Journal of the A.M.A. are libeled and condemned by the Food and Drug Administration of the U.S. Department of Agriculture, as impure, mislabeled and dangerous to health and life. Thus the Council "accepted" and the Journal advertised, in 1935 and 1936, a heart stimulant bearing the trademarked name Digitol, at the very time the Government was seizing and condemning interstate shipments of the drug because of mislabeling and misrepresentation that was dangerous to life. Also Ergot Aseptic was "accepted" by the Council and advertised in the A.M.A. journals when shipments were being seized and condemned by the Government because of adulteration and misbranding.

The A.M.A. Committee on Foods, "accepted" the "White Star and Chicken of the Sea" brand of tuna fish, and carried its advertisements in its popular health magazine "Hygeia." To make certain that the reader would have no misapprehension concerning the significance of the seal of the Association, the advertisement contained the legend:

"A pure food, honestly advertised. The Seal of Acceptance of the Committee on Foods of the American Medical Association is your best guarantee that the claims of quality for any product are correct and that the advertising for it is truthful. Look for this seal on every food you buy. White Star Tuna and Chicken of the Sea Brand Tuna have this acceptance."

The Food and Drug Administration was not impressed by the magic of this seal. It repeatedly seized shipments of this brand of tuna fish and ordered them condemned because they

"consisted in whole or in part of decomposed animal substance."

Quite frequently drugs are unconditionally "accepted" by the Council on Pharmacy and Chemistry, and recommended as safe to the medical profession and the public through the pages of the A.M.A. journals, and through its advertising columns, though they are highly poisonous and so dangerous that within relatively few years the high number of deaths which they cause comes to be recognized by the rank and file of the medical profession and by the public, and their use discontinued. The derivatives of barbituric acid, sulphonal, veronal and other sedatives and hypnotics are instances which come readily to mind. They have caused numerous cases of poisoning, insanity and death. Cincophen, likewise "accepted," caused many deaths due to the destruction of the liver by acute yellow atrophy.

Brands of ether advertised in the columns of the Journal of the American Medical Association, have been libeled and condemned frequently by the Food and Drug Administration. These ethers cause many sudden deaths of patients under anesthesia. The deaths could be prevented if the A.M.A. would warn its members of the dangers of impure ether and apprize them of precautionary measures and methods of checking its quality and purity.

The Army uses such precautionary tests. On one occasion it rejected 30,000 of a shipment of 50,000 cans of ether because of dangerous impurities. According to the evidence before the Committee on Agriculture and Forestry of the U.S. Senate, in 1930, the 30,000 cans of Squibb's Ether rejected by the Army were returned and sold in the open market.

Instead of protecting its members and the public, it was testified, the A.M.A. continued to advertise these brands of ether in its journals and suppressed data regarding their danger.

LET NOT THY RIGHT HAND—

Sometimes the very issues of the A.M.A. Journals that contain scientific evidence of the worthless or damaging nature of a product may also carry advertisements of it, incorporating claims that are belied by the articles. Though the A.M.A. censors demand of lay publishers that they sacrifice profits for the protection of their readers, they themselves eschew that policy.

In the issue of the Journal of the A.M.A. of July 9, 1932, is to be found a report by the Association's Council on Pharmacy and Chemistry on the lack of effectiveness of mercurochrome as an antiseptic. It details the falseness of the claims made in the advertisements of the product. Before this report appeared, mercurochrome had been advertised only occasionally in the Journal of the A.M.A. For some curious reason, the advertisements of mercurochrome in the Journal of the A.M.A. and in other magazines published by the Association, became larger, more frequent and intensive after the attack. And the Council on Pharmacy and Chemistry has continued its "acceptance" and subsequently renewed it.

FISHBEIN BOOSTED BLINDING DINITROPHENOL

The reading columns of the journals of the Association and other avenues of publicity are often used to stimulate the use of products unacceptable or not "accepted" by the Council. Such a case is Fishbein's pushing of the poisonous "reducing" drug dinitrophenol which has proved so tragic for hundreds of thousands of persons.

Dinitrophenol's biologic properties first came to light in France during the war, in connection with its use as a solvent of "dope" for airplane wings. High fevers, loss of weight, neuritis and deaths were traced to its poisonous action. Much research and study were expended on the drug on the Continent in the twenties. As a result it was barred from sale by law in England and Sweden.

Nevertheless, in the early thirties, the Journal of the American Medical Association undertook to recommend to the medical profession the use of the poisonous dinitrophenol for reduction of obesity. It began with the publication of an article by Drs. Cutting, Mehrtens and Tainter in the Journal of the A.M.A. Not content to stimulate the use of this poison in the columns of his journals, Dr. Morris Fishbein furthered its use among the laity through that vast practice of medicine which he conducts through syndicated articles in newspapers.

Dr. Fishbein's campaign to stimulate the use of dinitrophenol was engineered with such skill and facility as to be the envy of the most disreputable and unscrupulous quacks. They hastened to follow his lead. The drug counters of the country were soon laden with "reducing remedies" made of this poison.

The manner in which the physicians who are so stupid as to place their trust in the contents of the Journal of the A.M.A. and its editor, were led to administer this poison to their patients is illustrated by the following item appearing in the column of queries to the editor in the June 29, 1935 issue of the Journal of the A.M.A. (p. 2385).

"Alpha dinitrophenol is probably no more risky in this (case of obesity) than in other cases."

In this manner the editor advised and recommended the use of dinitrophenol. No more misleading statement has ever appeared in the vilest type of patent medicine advertising.

In its poisonous action dinitrophenol is devastating. In collaboration with Dr. George Cameron, I have demonstrated that dinitrophenol not only poisons the taker, but may cause monstrosity formation such as absence of eyes and ears in his or her offspring. As a result of the use of dinitrophenol, brought about by Dr. Fishbein and his associates, many persons died, many thousands have been blinded, disabled and maimed, and future generations have been victimized.

In sharp contrast with their hyper-intensive publicity methods in the case of "elixir sulphamlamide," Dr. Fishbein and his A.M.A. made no drive to stop the use of dinitrophenol. On the contrary, they used all their power of control and censorship of the press to hush the matter. Pressure was brought to bear against resolutions introduced by me before scientific bodies petitioning the Federal Government to step in and bar the use of the drug.

As a consequence, dinitrophenol may still be sold over the drug counter in some states; and doctors who are slow in catching up with their medical reading still may prescribe it, on the basis of Fishbein's earlier advices. Many malpractice suits by the victims against their physicians arising out of poisoning by dinitrophenol are being settled out of court.

To protect the profession against further malpractise suits for poisoning from dinitrophenol, and to protect the insurance companies issuing malpractise policies, the usual device is being adopted. The literature is being filled with sly reports of experiments to "prove" that dinitrophenol is not poisonous and does not cause cataracts. Thus Dr. A. M. Yudkin has reported in the American Journal of Ophthahnology and the Archives of Ophthalmology; "Dinitrophenol given in large doses does not produce lenticular changes in animals, nor does it aid in the formation of cataracts." The reports are useful in confusing juries. For "experts" testify falsely on their basis that dinitrophenol does not cause cataracts.

It would be far more salutary if the instigators of this outrage were brought to account. But the American Medical Association has built up for itself such power and such reputation and odor of holiness and sanctity, that it can regard itself immune from legal prosecution.

During all the time that the columns of the Journal of the A.M.A. were stimulating intensively the use of dinitrophenol, never once was it hinted that there was any question about the acceptance of the product by the Council. Emphasizing the irony of the A.M.A. food and drug "acceptance," the Council announced its "rejection" of the drug after its use had been made widespread through its own agencies and by its boss, Fishbein. This belated rejection was poor consolation to the blinded victims of the poison.

WHAT PRICE ACCEPTANCE?

The tale of Dr. Abbott which has been related illustrates one type of consideration which might motivate the "acceptance" of a product. A distinguished professor, scientist and retired dean of a College of Pharmacy, Dr. Henry H. Rusby, recounted to me the following tale which illustrates another type of quid pro quo, in the "acceptance" game.

President Joseph M. Flannery of the Standard Chemical Company of Pittsburgh, American producer of radium, summoned the doctor to an urgent conference in 1913. He was very much upset because the A.M.A. had refused to "accept" the American-produced radium products, and the claims made for them, in spite of the fact that Madame Curie had pronounced them to be fully up to standard. He despaired because a large investment was at stake and depended upon the "acceptance" of the Association.

"There can be no question about the quality of the product," he told the doctor. "I have tried to do everything possible to induce Dr. Simmons to grant us acceptance, without any success."

"Everything?" asked the doctor. "Is there not something that you have left undone?"

"But I would not dare to do that," said Mr. Flannery. "I would be afraid that I would be thrown out on my ear."

"Then do not say that you have tried everything," replied the doctor. After a few moments, the idea sank home, and with sudden resolve Mr. Flannery swore, "I'll be ______________ if I don't."

Two weeks later, the doctor again stopped off at Pittsburgh and found a jubilant Flannery. His product had been promptly approved and "accepted."

When the bosses of the Association were thus "induced" to accept the products of the firm they "went the whole hog." They accepted all the products. Included among the products thus accepted was a dilute solution of radium salts for internal consumption. This product, with the others was extensively advertised in the Journal of the A.M.A. and its use recommended to the medical profession.

This "accepted" radium drinking water has proved to be so highly poisonous and deadly that its use has been barred by law and by health authorities, after many deaths had occurred from its use. To cap the climax, Fishbein then editorially attacked the water, conveniently ignoring the fact that his A.M.A. Council had "accepted" it.

RESTRAINT OF DRUG TRADE

Steadily during the past three decades the monopolistic restraint of the American Medical Association over medical advertising to the profession and to the public has become more absolute. At the same time it also has become progressively less fair, less honest and more arbitrary in its attitude toward the manufacturer. This is illustrated by some of the grounds for rejection of products, the conditions for acceptance, and the actions taken.

The applicant for "acceptance" of a product must agree, in advance, that the Association will not be held legally liable for any damage sustained as a result of its actions. It is doubtful that such a stipulation barring redress would be ruled legal by the courts in case of tort or libel. But in case of legal contest, the manufacturer stands at so great a disadvantage with regard to medical and public opinion that even if he should win a lawsuit his financial losses would overshadow his gains.

The pharmaceutical manufacturers, like the rank and file of the medical profession, are deprived by the A.M.A. of their constitutional rights by this racket that does not trouble itself to stay within the skirts of the law in its coercion and restraint. Charges of monopoly in restraint of trade have been brought against the American Medical Association before a U.S. Senate Committee in 1930; and similar charges against Dr. Morris Fishbein and his Association were brought before the Federal Trade Commission in 1931. It is a tribute to the power exercised by the A.M.A. that these obviously true charges have come to naught.

Grounds for rejection arising from the character or quality of a drug preparation and from its lack of medicinal value are understandable. But the Association and the Council have fashioned additional arbitrary rules, of which the following are samples, for clubbing manufacturers and dominating their business:

1. The A.M.A. and its Council assume the right to dictate the name under which a drug preparation is marketed, and of arbitrarily ordering a change of name.

2. A drug product may be rejected no matter how valuable it may be, if it has been developed and marketed by a firm that has not submitted its other products for "acceptance," or if the Council has chosen to reject other of its products.

3. Drug firms may not use in their advertising or literature reference to the scientific work of any investigator who is not a member of the A.M.A. or approved by it; and everything must be submitted for censorship to the A.M.A. This rule is especially severely applied to prevent dissemination of knowledge of nonsurgical methods of treatment of conditions for which surgery has been made accepted practise.

The first rule serves the purpose of turning over the business of a firm to a competitor, or of forcing a firm to enormously increase its advertising expenditures.

A ROSE BY ANY OTHER NAME—

An instance of arbitrary order of change of name of a product by the Council as a condition for "acceptance" and access to many of the advertising media of the country, is "Antiphlogistine." This product is a heat-retaining substance impregnated with counter-irritants. Its use is external; it has been in general use by the medical profession for a longer time than the American Medical Association has existed; and the results of its use have been uniformly satisfactory. Under these circumstances there would appear to be no reason why the firm should not be permitted to continue to serve the profession and the public.

The A.M.A. and its Council, however, demanded as a condition for "acceptance" that the name of the product be changed to "cataplasma kaolini." This would have involved loss of the "good-will" entailed in the name "Antiphlogistine," that had been built up in a period of more than half a century of service to the public and the profession and through the expenditure of a fortune in advertising. It would have meant abandoning a part of the trade and market built up by the firm to competitive firms who would have the privilege of marketing a similar product under the same name. The competitive firms would benefit from the advertising which the firm would be compelled to place in order to acquaint its following with the new name. The chief beneficiaries of the A.M.A. ukase would have been its own advertising business and the businesses of the competitors thus favored by the Association.

Arbitrary orders of change of name are becoming more frequent; and failure to comply by the prejudiced firm is becoming more often the basis of "rejection" of drug products. One such recent order resulted in barring the Abbott Laboratories from continued advertising of one of its products originally marketed under the trademarked name "Nembutal," within a short time after the death of "Doc" Simmons.

DEPRESSION-PROOF "BUSINESS"

The A.M.A. and its bosses have seized tremendous commercial power through the testimonial rackets. As their domination of the drug industry has become more absolute and arbitrary, the opportunities for making it profitable have proportionately increased. The annual report and balance sheet of the American Medical Association amply attest to this. For the year 1936 the Association reported a new high, one million four hundred thousand dollars, in its steadily rising profits that were in no wise checked by the depression. The Journal of the American Medical Association has become one of the most lucrative advertising media in the country. The powers which they exert over the drug industry are sufficient to insure its journals as much advertising revenue as they desire. There is nothing to indicate that advertising is the sole source of profits derived from the monopoly set up by the Association; or that all the profits which accrue from it are to be found in the balance sheet of the Association.

"DIGGING UP" ADVERTISING

An illustration of how the A.M.A. can increase its revenue is the experience of the firm of _____ & Co. The full name is omitted because the firm fears the reprisals of the A.M.A. and threatened to deny the story if their name is mentioned. _____ & Co. manufacture and market through their pharmaceutical division some of the most reliable endocrine gland products available on the market. In the past they have marketed and advertised these products without making any assertions or claims of curative or therapeutic value. Their labels merely stated the gland from which the preparation had been made and the method used in its manufacture. No policy could be regarded as more ethical or honest; and none could better serve the interest of the public and of the medical profession.

But the ethical marketing policy of _____ & Co. did not serve the interest of the American Medical Association and its bosses. For _____ & Co. found it unnecessary to push their products in expensive advertising campaigns. Their quality was known to the profession and their honest labels served to sell them without high pressure advertising. As a consequence the American Medical Association did not get much of their income through the route of its advertising department.

The representatives of the A.M.A. openly pressed the Company for more advertising business. They made no headway, because the honest policy of _____ in making no therapeutic claims for their products made them invulnerable to intimidation, coercion and other forms of racketeering.

A new line of approach to _____'s advertising funds was then laid. The company was given to understand that it was expected to make claims of curative or therapeutic value for its products as a condition for their acceptance. The object of this ultimatum, which negates completely all principles of the "ethics" of drug marketing laid down by the Association itself and violates the interests of the public by encouraging self-medication, was quite apparent to the officers of _____ & Co.

"They are trying to get us out on a limb," said a spokesman of the company, "by forcing us to make claims for our products. They will then be in a position to force us to take as much advertising as they wish."

Nevertheless, _____ & Co. did not dare to disobey the ukase. They are now making a gesture in the direction of therapeutic claims on such products as adrenal cortex. The inside covers of the boxes now bear the legend: "Uses, pernicious vomiting of pregnancy."

THE A.M.A. AVENGES ITS HENCHMEN

The adrenal cortex hormone is so important a substance that it has deservedly been given the name "vital hormone." It was originally isolated by several workers including Stewart and Rogoff, Hartman and others about 1928, Commercial preparation of a highly purified product was made possible by the findings of Drs. Swingle and Pfiffner of Princeton University; and they sold the patent covering their method of preparation to Parke, Davis & Co.

When Professor Swingle and his co-workers obtained their patent, personal jealousy between the groups of research workers flared up into venomous hatred. The A.M.A. sided with a member. The product was rejected by the Council without consideration of the facts and with deliberate distortion of the truth. Advertisement of the products was barred in all the journals and magazines dominated or influenced by the A.M.A. The editor of Science, Dr. J. McKeen Carttell, announced that he would not accept any further publications on the subject after the appearance of important initial reports.

How thoroughly intimidated are even the reputable drug houses by the A.M.A. is revealed by the fact that Parke, Davis & Co. did not dare to fight back at these false and demonstrably malicious attacks on their preparation of the hormone in spite of their large investment in it.

They undoubtedly feared that if it should make any semblance of fighting back or attempting to defend themselves, the malicious reprisals in other directions would follow, which would prove to be even more costly financially. The A.M.A. published fictitious analyses of the product which were absolutely belied by the investigations of some of the most distinguished chemists of the land. The product was falsely pronounced to be worthless in publications in the A.M.A. journals; and no replies were permitted to enable disproof of the utterly false allegations. Libelous attacks were made on the product in the journals of the Association and in letters written to intending users. The market for the product was virtually destroyed.

"HIGHBINDERS OR RACKETEERS!"

Mr. Loeser has had the admirable courage to openly expose in a 1936 publication of his firm named the "Journal of Intravenous Therapy" the "acceptance" tactics of the A.M.A. In an article entitled "State Medical Society Protests Misinformation and Misconduct of Council on Pharmacy—Expositions of Council Methods & Frauds Perpetrated on the Medical Profession," Mr. Loeser related the experience of his firm.

Fishbein and his A.M.A. Council on Pharmacy & Chemistry, Mr. Loeser reported, had persistently rejected and condemned the products of Loeser Laboratories which pioneered in the field of medical preparations for injection into the veins. One fine day, the A.M.A. sent an agent to solicit advertising for its journals from Loeser Laboratories.

"We were informed that the Council would accept one product to allow advertising in the State Medical Journals.

"It required acceptance of two to allow advertising in the Journal of the A.M.A.

"The Council informed us that U.S. Pharmacopoeia remedies are beyond their scope . . . a subterfuge and untruthful . . . clearly indicated by the number of U.S.P. products in the New and Non-Official Remedies (the list of accepted drugs) some under coined titles, every one a violation of the Council rules.

"They suggested Loeser's Intravenous Solution of Mercury Oxy cyanide and it was 'accepted' by the Council . . .

"For approximately three years Loeser pharmaceuticals were advertised in many of the State Medical Journals.

"Having in mind statements of the Council regarding the rules, we were astounded by the Council's acceptance of a solution of calcium chloride with the addition of urea under a non-descriptive title and the appearance of the advertising in the Journal of the A.M.A. We asked for an explanation, pointing out that this preparation violated the rules as to simple scientific solutions and the non-descriptive name.

"Why should an ethical product be confined to State Medical Journals and a non-conforming pseudo-scientific imitation be given an advantage in competition?

"THIS AND OTHER ACTS OF DISCRIMINATION AND LATER CONDUCT CONFIRMED OUR BELIEF THAT DR. FISHBEIN AND THE COUNCIL WERE MERELY ACTING AS AGENTS FOR FAVORED FIRMS.

"The unsatisfactory and evasive replies prompted us to cancel our advertising contract with them.

"HIGHBINDERS OR RACKETEERS"?

"Shortly after the cancellation of advertising contract the Council published in the Journal of the A.M.A. what were purported to be refusals to accept several Loeser pharmaceuticals.

"We present reprint of one regarding Loeser's intravenous solution of Calcium Chloride, the advertising of which repeatedly appeared in State Medical Journals and the literature approved by the Councils own committee. We urge every physician to scrutinize the Council's statements, and compare the numbered paragraphs with our corresponding numbered statements of facts. By doing so you will realize that State Medical Societies act wisely in demanding honest information. It will give a physician a comprehension of the tactics employed by this supposedly scientific group.

"It is hard to see in what manner these activities of the A.M.A. differ from the ordinary blackmailing rackets."

FISHBEIN NULLIFIES THE CONSTITUTION

Having tasted the fruits of limited and indirect monopolistic control, Fishbein and his Association have conceived grandiose ideas of an absolute and direct monopoly of the drug industry. As the first step in such control, Morris Fishbein and his cohorts are bending their efforts to throttle scientific organizations with the prime purpose of monopolizing completely all avenues of publication of matters pertaining to medicine. In this manner they will be able to avoid any leak of scientific information to even the scientific groups interested; and will be able to completely bar any publicity to the general public.

The first move taken by the Association in the direction of attaining this objective that came to the notice of the public was the throttling of the publication of a paper on a new synthetic drug by Herman Seydel before the Chemical Society at its 1937 convention. Seydels drug is no worse or better than numerous drugs extensively advertised in the journals of the A.M.A.; and in being non-poisonous it is better than some there advertised. It was tested and approved by a number of competent physicians. On the usual pretense, protection of the health and lives of the public, Fishbein and his clique undertook to abridge the freedom of speech of the members of a society which is in no wise connected with the A.M.A. They demanded that Seydel be prevented from presenting his paper and the Society acceded.

It was amazing indeed, that the press and the Chemical Society tolerated this wholly un-American infringement on the rights of others. This act was part of a scheme of expansion of the monopoly of advertising and publicity and the restraint of the drug and chemical industries.

FISHBEIN CLAIMS DRUG DICTATORSHIP

At the Rochester meeting of the American Chemical Society in September 1937 Fishbein, drunk with the powers which he had been permitted to usurp over the chemical and drug industries of the country, threw caution to the winds and voiced his ambition and intent to set up for himself an absolute monopoly of the drug business. He proposed that the American Medical Association, in other words himself, be given control of all medical discoveries and patents, and more immediately of the patents which have been developed in the universities of the country.

Patenting of medical discoveries he justified with the statement: "Why should . . . a physician give freely to everyone the product of his brain when the state refuses longer to consider him as a philanthropic worker for the benefit of mankind?"

He therefore seeks, he said, to rectify the social injustice to the physician; but not by permitting the individual to enjoy the fruit of his research labors. He wishes to bar any such contingency because of the "corrupting influence" of an honest reward to the individual physician for his labors. Likewise, he discerns a "corrupting influence" on universities which hold medical patents and enjoy the financial returns therefrom. Industry, he said, certainly cannot be trusted.

Dr. Fishbein can only see one solution for eliminating the corrupting influence of the millions of dollars that now flow from medical discovery and invention—their diversion into the pockets of his incorruptible self and of his clique. He trusts himself alone.

Even the New York Times which staunchly has supported the medical rackets when they do not conflict with the social service, was moved to comment upon Fishbein's proposal (September 5, 1937) in the following vein:

". . . there is no evidence that a virtually monopolistic control by a single organization of all meritorious patents taken out by physicians and professors in universities is desirable."

A NEEDED REFORM IN MEDICAL PATENTS

A reform in medical patents of another character is urgently needed. Most of the essential life-saving drugs that have been developed by recent chemical and medical research, such as the gland hormones, have become subject to such merciless and intensive exploitation, and the profits demanded by their patent owners is so exorbitant, that they are entirely beyond the reach of all but the wealthiest patients. In many instances the German Dye Trust and their allies alone profit. This situation means the denial of health, sanity and life to hosts of ill.

The solution indicated is the reverse of that advocated by Fishbein, turning over the patents to the A.M.A. for exploitation. The patent laws should be amended to cause all such patents to revert to the Government for public welfare; and to provide a pension for the inventor. France denies any patents on drugs. But this is not wise; for it offers no incentive for discovery and invention. The patent-pension plan stimulates research and discovery. This reform would do more to bring down the cost of medical care than any Socialized Medicine plan.

NEW JERSEY SOCIETY DEMANDS INVESTIGATION

Capping the climax of cumulative proof of the utter dishonesty and untrustworthiness of the entire food and drug acceptance racket of the American Medical Association is the evidence given by one of the constituent societies of the American Medical Association. The New Jersey State Medical Society at its annual convention May 2, 1935, adopted a resolution condemning its parent organization, the American Medical Association, for racketeering in foods and drugs. It read as follows:

". . . Whereas the Committee on Food and the Council on Pharmacy and Chemistry, and the Investigations Bureau of the American Medical Association have exercised selections unwarrantably in the notices of judgment they have published, and have permitted the licensee to use their seal on the advertisements of products that are even at the same time being successfully prosecuted by libel actions under the Food and Drug Law, and

"Whereas it is our duty as physicians to assume leadership in promoting free and open discussion of a condition concerning which we should have expert knowledge if we had honest information.

"Therefore, be it resolved that the New Jersey State Medical Society do hereby urge and as representative of the ethical physicians of the United States do hereby demand a complete Congressional Investigation of the enforcement of the present Pure Food and Drug Law, the investigating committee to have full power to call individuals and records under oath, before any new pure food and drug legislation be enacted by Congress. . ."

What could more perfectly prove the corrupt political nature of the organization of the American Medical Association than the fact that the political bosses of the Association, under Fishbein's leadership, barred the introduction of this resolution of a constituent society at the annual meeting of the Association? Of equally serious import is the fact that no newspaper published these highly important and sensational charges and resolutions.

A MENACE TO THE PUBLIC

Enough has been related to indicate that even were the officers of the American Medical Association men of the highest integrity, their arbitrary control of the drug industry would constitute a menace to the interests of the community as unwarranted as are absurd the pretensions of its editor and Council to omniscience and infallibility. Such tremendous and arbitrary power over an industry, the business of which reaches values of billions of dollars annually with profits which reach hundreds of millions, is beset with temptations which few honest mortals could resist. But medical politicians and bosses of organized medicine are rarely honest. The representatives of the A.M.A. openly acknowledged betrayal of public confidence in the hearings during the Investigation of the Administration of the Federal Food and Drug Act by the U.S. Senate Committee on Agriculture and Forestry of the Seventy-first Congress.

The temptation to convert new and important drugs into secret remedies to be used for the enhancement of their reputations and incomes is so attractive to the overlords of medicine that they are making it "accepted practice." The excuse offered the public is that the remedies are undergoing clinical testing. The implication is that the rank and file of the profession are not competent to judge the effects of drugs on their patients. If that be true, they must also be adjudged incompetent to practice medicine; for practice requires constant evaluation of the effects of drugs and treatments on variably responding patients. The excuse is obviously false.

In the creation of a group of secret remedies the "acceptance" racket is now supported by the new Food and Drug Act. Its ridiculous restrictions, which mark an extreme swing of the pendulum in the direction of absurd caution, bars the public from the benefits of many drugs of the highest value unless they pay high fees to medical "leaders" who alone may use them. Drugs like histaminase, for the relief of serum sickness and allergy, and corticosterone, the active principle of the adrenal gland cortex were widely used abroad for many years before they were admitted to use in the U.S. Under the impossible terms of our drug act, the introduction of such drugs is long delayed and some may never be admitted for use in this country unless the A.M.A. and its Council see fit to approve them. The set-up for extortion of the public, blackmailing of the drug trade, and monopoly of the industry is perfect. As the subsidiaries of the subsidized German Dye Cartel say, only the most "efficient" firms will survive.

What is possibly the most flagrant violation of the interests of the public and of the medical profession is the deliberate stimulation by the American Medical Association of the use of denatured foods that have been robbed of nutrient value, in return for the placement of high-priced advertising in its magazines. Thus the American Medical Association, through Dr. A.J. Cramp of its Department of Investigation (and Propaganda) offered to Dr. Barnard of the Baking Institute, in a statement published in the January 1925 issue of Baking Technology, to propagandize the medical profession and the public and lead them to believe falsely that white bread is "most wholesome." This offer resulted in much high-priced, full page advertising by millers and by the American Institute of Baking in the Journal of the A.A.A. and its popular magazine, Hygeia.

Thus, by betraying the interests of the public and its health and the medical profession, the American Medical Association bosses were enabled to tap rich, new sources of revenue and graft. The Council on Foods of the Association, naturally, prepared the way for the advertising by "accepting" degerminated wheat, bleached with benzol peroxide and nitrogen trioxide, as in the case of "Dakota Maid Flour" (Journal of the A.M.A. March 13, 1937, page 885).