A CONSPIRACY TO ESTABLISH A PHYSICIANS' TRUST.
In nearly if not all of the State Legislatures now in session, bills have been introduced which seek to compel manufacturers of proprietary and patent medicines to make public the formulas and private processes by which their preparations are made. A bill of similar import, dealing with interstate traffic in medicines of this class, has also been proposed in the House of Representatives at Washington.
The large number of these bills, their apparent spontaneity, and the noisy clamor of their advocates, would make it appear that the American people had, all of a sudden, awakened to the realization that they have long been victims of some monstrous wrong, and that at last, in anger and wrath, they had arisen in their might to wreak revenge upon the authors of their supposed miseries. That such, however, is not the case—that, in fact, there is no real demand from the general public for this legislation, except such as has been, by false representations, created by certain selfish interests, is well-known to all who have followed the current events in the drug trade for the past three or four years.
In order, therefore, that there may be a clear understanding of the real meaning of this apparently spontaneous movement, and of the influences which are behind it, and to the end that justice be done, not only to the manufacturers whose property it is proposed to destroy, but to the people in general, as well as to the 40,000 retail druggists of the country, of whose total volume of business at least 60% consists of proprietary medicines, we desire to make this plain statement of facts.
There is an organization of doctors known as the American Medical Association. Though it has been in existence for nearly 60 years, it had, up to three or four years ago, less than 5,000 members, out of a total of nearly 150,000 physicians in the entire country.
It was about or a little before that time, it will be remembered, that the great trust movement began—when the people of the United States, all of a sudden, seemed to have tired of doing business on individual lines, and were madly rushing into all kinds of pools, trusts and combinations. It appears that this contagion spread even to portions of the medical profession, for, all at once, a novel and well-conceived plan of organization was adopted by the clique in control of the American Medical Association, the purpose and design of which was to organize all of the doctors in the country into one gigantic medical trust.
There were at that time, and had been for many years, hundreds of county, state and other smaller medical societies, but these were all independent, and had no connection, the one with the other, beyond that bond of sympathy which might naturally be expected to exist among a number of men engaged in the honorable undertaking of trying to uplift the calling or profession to which they had devoted their lives. The new plan proposed to change all this, and contemplated a grand scheme of organization by which all of these small, independent societies should be merged into, or become mere dependents on the American Medical Association, and subject to its laws and regulations. The project was loudly proclaimed and eloquently advocated in the recognized "organ" of the association, known as the Journal of the American Medical Association; and the independent medical journals, not yet scenting danger or seeing the ulterior motives behind it, joined heartily in the endeavor to make the scheme a grand success. Paid "organizers" were employed, who visited the local societies, and these, co-operating with the independent journals, were able, in less than three years, to coax or coerce 15,000 physicians into affiliation with the great national association; so that, at the last meeting, it was announced that the membership was in the neighborhood of 20,000, or four times as many as it had been possible, after working 55 years along the old lines, to muster on the rolls of the association.
One of the conditions of membership in the association is the subscribing to the official organ, mentioned above. This journal is published from the sumptuous and spacious headquarters of the association at Chicago, and we learn from the report of the Board of Trustees at the last meeting, that the total income of the journal for the year 1904 was $254,731.45, or probably more than that of a hundred of the smaller independent journals of the profession.
Not satisfied with the one national organ, great and powerful though it is, and resentful of the spirit of revolt which was occasionally manifested in the independent medical press, each of the state societies was induced to establish a journal of its own, ostensibly to publish the proceedings of the association, but really, as it has afterwards developed, to become whippers-in and drummers for the American Medical Association and its official organ. Then there began a systematic campaign against such of the independent journals, as had refused to mould their opinions to suit the leaders at Chicago, and members of the association were boldly urged to stop their subscriptions thereto. and to refuse to read any sample copies of the same which might be sent to them. In pleased anticipation of the ultimate success of this effort to stop free discussion and to monopolize the medical press, the California State Medical Journal complacently tells us "that the day of the privatelyowned medical journal is passing away and its place will be taken by the Journal of the American Medical Association and the various state journals."
With the amazing growth in membership, as detailed above, with the constantly-increasing strength and prosperity of the official organ and its auxiliaries, the officers at Chicago assumed an air of arrogance and insolence, not only towards those physicians who had refused to come into the fold, and to the independent medical press, but also towards the manufacturers of. and dealers in, all kinds of drugs and medicines in the United States. About a year ago these medical autocrats started out on a project to regulate and control the drug industries of the country, and their initial move was the issuance of an edict to the manufacturers of that class of proprietaries intended exclusively for physicians' prescriptions, notifying them that they must forthwith furnish to the Association's Council on Chemistry and Pharmacy, the names and exact quantities of the ingredients which enter into the composition of their several remedies, together with their methods and secret processes of manufacture, all of which should be so complete as to enable the council to "verify them;" that is, to reproduce the preparations, "and to determine their future status from time to time." It was at the same time declared, that unless the manufacturers acceded to these demands, their remedies should be refused admission into a volume which it was proposed to publish, that would contain all remedies of the kind that members of the American Medical . Association could "ethically" prescribe or use in their practice. These manufacturers were also warned that failure to comply with the requirements thus glibly set forth, would mean future exclusion from the advertising pages of the "organ," with all the pains and penalties of a general boycott which such exclusion was supposed to carry with it.
It seems, however, that these officials took themselves too seriously. The manufacturers, apparently, did not place as much importance in the official endorsement of the "Council" and in its implied threat of a boycott as these egotists had anticipated. Comparatively few of them seemed willing to take this Council of Chemistry and Pharmacy into their confidence and to entrust to its keeping the valuable trade secrets upon which the prosperity of their business is based, and it was noticed that they began to withdraw their advertisements from the "organ" until, at this writing, the amount of such advertising remaining in the journal is insignificant as compared to that it carried in the heydav of its prosperity.
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Finding their principal source of revenue thus suddenly cut off, disappointed in their expectations, but unable to retrace their steps or retrieve their position, the gentlemen in charge at Chicago seemed to have become embittered and filled with hatred and chagrin, not only toward that class of proprietaries which they had sought vainly to control, but to those which are advertised and sold to the public as well. A few months ago, as if by concerted action, the Journal of the American Medical Association and the auxiliary state journals began to teem with articles on the danger to the public from patent medicines, and various suggestions were proposed to overcome "the great evil." The idea of educating the general public to the danger to which it was thus exposed was first proposed, but immediately abandoned as too slow and difficult, and it was finally determined to strike at the manufacturers of these articles through Congress and the State Legislatures. As a starter on this program of destruction, as we learn from the official organ, a Committee on Legislation was appointed, and the following resolutions were adopted:
Resolved, That the Committee on Legislation of the American Medical Association be, and is hereby directed to bring the influence of the entire medical profession to bear in securing the enactment by various State Legislatures of an act, as nearly as possible uniform, prescribing that all "patent" or "proprietary" incdi cines shall carry an exact formula of their contents plainly printed on each original package, and make the contents conform to the formula.
Resolved, That the said committee memorialize Congress to enact a law which shall prescribe that all "patent" or "proprietary" medicines and all advertising matter relating to the same which shall fail to comply with the foregoing conditions shall be excluded from the United States mails and from interstate commerce.
In order to effectively carry out this propaganda, the committee recommended the association "to establish a Bureau of Medical Legislation, to be located in the association's building in Chicago." That this committee has
faithfully and energetically been at work is evident from the fact that a bill, framed along the lines indicated in the resolutions above quoted, is now pending before Congress, and that, almost simultaneously, bills practically identical in terms and verbiage, and framed in accordance with the instructions of the Legislative Committee, have been introduced in nearly if not all of the State Legislatures now in session.
From the facts as we have detailed them, it can be seen that this crusade is not the result of a great national uprising, as the uninformed might imagine, and as it is sought to make the legislatures believe, but that it all proceeds from the clique of political doctors who, for the time being, are in control of the great American Medical Association. Now, for whose benefit is this coterie of physicians laboring so earnestly and with such holy zeal? Of course, if we are to believe their own professions, it is all for the benefit of the "dear people," and the American Medical Association is purely a benevolent institution, organized and maintained solely for philanthropic purposes, and without hope of reward or selfish advantage to the association itself, its individual members, or to the officials who are at present directing its activities. But the average legislator will understand, if the average citizen does not, that behind most special legislation, however glozed over it may be with humanitarian pretensions, the controlling motive is pecuniary gain or greed of power. And we do not believe that Congress or any State Legislature can be hoodwinked and deceived by the false play of the agents of this Great Medical Trust into passing laws whose purpose and design is to crush out and destroy all competition in the healing of the sick, and to give to its members a complete monopoly of the whole field of curative therapeutics, so that it will be impossible for a man to get a simple remedy for a cold, headache or other minor ailment without first hunting up a member of the American Medical Association and paying him a prescription fee.
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The arrant hypocrisy in the pretensions of humanitarianism on the part of these doctor-politicians ought to be apparent to the most guileless individual, but if proofs be needed they shall be forthcoming, and out of their own mouths. We cannot, of course, follow them behind the closed doors of their secret deliberations, and it is natural that they should not proclaim their real motives to the public; but occasionally a member, more boldly brutal than his fellows, or one lacking discretion, or for the moment being off his guard, gives the whole snap away and lets the feline out of the bag. And in order to see exactly how they talk when the public ear is not attending, and when, therefore, there is no ocasion for assuming a benevolent air, we have taken the trouble to go carefully through a few copies of the Journal of the American Medical Association and one or two of its satellites, and we give extracts therefrom, which may help to reveal the real design behind all this agitation against proprietary and patent medicines, and against the druggists who make their living by selling them.
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To begin with, we will quote from the Journal of the Association itself, which is the source of inspiration for all the smaller association and other subservient organs scattered throughout the country. The Journal, with its income of a quarter of a million dollars a year, in its issue of May 6, 1905, urges physicians not even to use one of those proprietary preparations that are especially made for them, and gives as its reason, that "the patient will become acquainted with what the preparation is good for, and will buy it direct," and consequently some doctor will be cut out of a prescription fee.
Before the Academy of Medicine of New York City, January 18, 1906, proprietary medicines and their bearing on the interests of the association were being discussed, and Dr. Peabody, after considering the difficulty of getting rid of the evil, is reported as declaring, finally, that "we can't prevent people from buying what they want." With this rather pessimistic utterance, Dr. W. Gilman Thompson seemed to take issue, for he proposed as a means to this desired end—that is to prevent people from getting what they want (in other words, to compel them always to go to a doctor and get a prescription before taking medicine) — that:
The Academy support and work for a bill compelling the labeling of all such preparations with a statement of the character and quantity of the ingredients contained in them, and providing a heavy fine for failure on the part of the manufacturers to comply with it.
The California State Medical Journal, quoted above, in its issue for September, 1905, says:
Ask any pharmacist what will eventually happen if you give a patient a prescription for one of these proprietaries. He will tell you that in due course, the patient, or his wife, or his mother, or his children, or his sisters, or his cousins, or his aunts, or his wife's friends will come into the store and buy more of the same stuff— but without a prescription. In other words, you have lost a patient.
In an article in the Journal of the American Medical Association, March 18, 1905, page 894, it is charged "that the druggists are cutting the doctors' throats by selling patent medicines," and an implied threat is made to the •druggists in the words that they "ought to see the propriety of not working against the doctors' interests;" that is, by selling patent medicines to the people, and in this way cutting the doctors out of prescription fees. We see no love for the dear people here.
Dr. Horatio C. Wood, Jr., one of the leaders in the present crusade, jn the. Journal of the American Medical Association, June 10, 1905, makes a calculation of the amount spent only in advertising proprietaries, and says that that advertising "represents just so much as coming out of the pockets of the doctors."
In an article in the Journal of the American Medical Association, September 9, 1005, page 801, doctors are told that it should be a rule that no proprietary medicine should be delivered to the patient in the original package—this precaution being taken to prevent the purchase of future supplies without a prescription.
Dr. Horatio C. Wood, Jr., again in the Journal of the American Medical Association, June 10, 1905, speaking of physicians' proprietaries, says: "Indeed the employment of these fancy-named specialties is a direct temptation to self-medication," by which, of course, the doctor is the loser, since it cuts him out of a prescription fee. How altruistic!
In an article in the Journal of the American Medical Association, March 4. 1905, objection is made to proprietaries on the ground that "they encourage the patient to prescribe for himself, and, as the proprietary manufacturer becomes richer, the physician becomes poorer." It is the doctors' interests, and not those of the people that are here considered, it seems to us.
The Medical Mirror, January, 1906, says: Conditions of medical men in the big cities are appalling. In this city (St Louis) there are more than 1,100 doctors who are not making a decent living. Doctors who are sober, honest, brainy, educated and talented, are living on 10-cent lunches in the saloons, go unshaven and with shiny clothes on their backs. • * • But, Allah he praised for one thing, the tocsin has sounded! A campaign of education has been inaugurated by a number of reputable and trustworthy journals in various parts of the country, new light is being disseminated, and little by little it is breaking through and dispelling the gloom. Legislation against quack, proprietary and patent medicines is going merrily on in several States.
The Medical Times, April, 1905, page 117, in a leading editorial on proprietary medicine, says:
This is a subject vital to every physician. * * * We will merely repeat here the specific statement we have already made, to the effect that in one year $62,000,000 has been expended on patent medicines in the United States, enough to give to every practitioner in the country a yearly income of $2,000. * * * In the face of such facts as these, all talk of love of humanity, altruism, selfabnegation and the like, becomes cheap and nauseating. • » • It appears to us that such buncombe should give place to homely commonsense.
If we had the time we could fill a volume with just such extracts, revealing how these doctors discuss this matter among themselves and in their journals, where there is no necessity of donning the cloak of hypocrisy, or to cant and prate about the public good. But we shall waste no more time on this unpleasant business. What we have printed is sufficient to strip this medico-political clique of their altruistic pretensions, and to exhibit them in all their coldhearted brutality.
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But these philanthropic gentlemen have other and even more radical legislative schemes up their sleeves, as we shall see. Muffled up in a profound self-conceit, and forgetful of the fact that they are living in a free country, they want to make it an infamous crime to doubt their infallibility, or to criticise their conduct. In the Journal of the American Medical Association, a short time ago, there appeared an editorial with the startling heading, "Treason Against the Government." In that article a New Orleans paper was most severely arraigned for presuming to criticise the physicians in charge of the U. S. Public Health and Marine Hospital Service for failing to successfully combat the yellow fever in the recent epidemic in that city.
The Journal says:
It Is one thing to discuss debatable theories and to expose dishonesty wherever found, but the events of the epidemic can not by any artifice be twisted into any excuse for this New Orleans paper. * * * The time is close at band for the creation by statute of a new variety of treason. * * * If it be treason in time of war for a man to betray his country's military plans, It certainly should be made treason for a man or a publication in time of deadly peril from disease, to foment, by false allegations, public lack of confidence in the government's plan of rescue, and in the integrity and ability of the men (that is, the physicians) who risk their lives to save the community froni unnecessary deaths. Than this, no treachery can be more base. Physicians, citizens, and the reputable press should join in asking stringent penalties for this crime against the nation, against humanity.
Treason is the crime of highest degree. The punishment in all countries for the offense is death. And yet it is proposed that the "mere fomenting of a lack of confidence" in certain subordinate government officials (if they happen to be doctors) shall constitute the offense, and this notwithstanding the Constitution declares that:
Treason against the United States shall consist only in levying war against them, or in adhering to their enemies, giving them aid and comfort.
In the early days of our country one of the political parties of the time sought to keep itself in power and strengthen its hold on the government by making it a crime to publish "any false, scandalous or malicious writing against the government of the United States, or either house of congress, or the president, with intent to defame them or bring them into contempt or disrepute." Such an attempt to stifle constitutional discussion, and to throttle the press, aroused the indignation of the American people to such an extent that the party responsible for the measure was driven from power, and the infamous Sedition law was wiped from our statute books forever. But even those partisans, bitter though they were, only proposed to punish the offense with fine and imprisonment, and then only for criticisms on the highest officials of government. But here it is urged by the organ, the representative, the mouthpiece of the American Medical Association, that it shall be treason to criticise mere subordinate officials, provided they be doctors, and that the punishment shall be death!
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Not satisfied with this infamous attempt to muzzle the press, and thus prohibit criticism of their doctrines and conduct, and fearing that even the compulsory publication of the formulas may not quite effect the purpose they have in view, they seem determined to make doubly sure the monopoly they seek by denying to the proprietary manufacturers the use of the United States mails and excluding them from interstate commerce.
And so we learn from the special Washington correspondent of the National Druggist, in our February issue, that the Legislative Council was in that city and, among other things, was "asking the government to exclude from the mails and from interstate commerce all proprietary remedies'' whose manufacturers refuse to comply with the demands of the American Medical Association. That this council was but following out instructions from the association itself appears from the following extract from the report of the Committee on Legislation (Journal of the American Medical Association, July 22, 1905,) as follows:
It has been suggested that postal regulations governing the transmission through the mails of objectionable medical literature, or of alleged medical matter, ought to be enacted. These matters in due season will be taken up by the heads of the legislative departments of the government at Washington, and, when properly formulated, will be brought before the National Legislative Council.
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Fearing that, after all, the results they are aiming at cannot be attained by bringing fair influence on Congress and the State Legislatures, as they are at present constituted, it is proposed that the association enter actively into politics and try to get its members elected to the legislatures, and the following excerpt is also taken from the report above mentioned:
Your committee has felt itself embarrassed from time to time by the fact that it has had comparatively few representatives of its profession in the Congress. This was sufficiently exemplified in the Fifty-eighth Congress, in which there were but two medical men in the Senate. * * * In this connection the committee urges that in the legislative field the duty of the profession to themselves and to the public is very distinct. * * * No profession can complain if it is the victim of inimical legislation passed during absence from these posts of duty.
Not satisfied with working their way into Congress and the State Legislatures, they are trying to get a special representative in the highest Councils of the nation, where he will be in a position to wield the greatest influence in behalf of his association; and so, the Legislative Council, on January 10, adopted a resolution urging the members of the association to work for the establishment of a special Medical Department, whose Chief should have a place in the Cabinet of the President of the United States.
As showing the effective work that this committee has already done in this scheme of getting into the legislatures and controlling legislation in the interest of the American Medical Association, we will quote once more from the report of the Committee on Legislation, as made to the Association at its last meeting, which will be found in the Journal of the American Medical Association of July 22. 1005. page 259. According to that report the Committee at that time had an emissary in every county in the United States working quietly to create sentiment in favor of the legislative ideas of the association. The Committee further reported that:
It has secured a list of local political leaders of every organized and recognized political party in the United States. The list already embraces the names of several political managers in each of 900 counties, the entire list aggregating in excess of 11,000 names. Through this list the central committee is in position to bring questions of pending legislation to the serious and thoughtful consideration of the men who, in their respective localities, exercise a preponderating influence in determining political action. • • « The political list is arranged so that the dominant politics of each county and of each congressional district is indicated, as well as the political affiliations of each member whose name appears on the list, t thus happens that we are able to move with a certain degree of accuracy in invoking political influence in behalf of such measures as are taken up by your committee. This list will be kept alive by asking for revisions from time to time, especially after each general election, and will, we are sure, prove to be an effective medium of action in the agitations which arc pending in the immediate future. The National Legislative Council is to be recognized as one of the most important elements in the mechanism of national agitation. It is before this body that all questions of proposed or pending legislation touching questions of interest to the medical profession are submitted for careful consideration. • • * The championship of a measure by your committee is accepted by the Congress as the championship of the American Medical Association, which, being the representative organization of the medical profession of the United States, makes its voice, in effect, the voice of the entire profession.
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There may be those who, having a high opinion of the almost sacred calling of the physician, imagine the American Medical Association is a great benevolent institution, whose only aim is the public good. But it seems to us. if the acts and utterances of the officials now in charge of the organization fairly and justly represent its policies and principles, that it is rather to be feared as a public enemy. Here is a body of men much above the average in force of character, ability and standing in their communities, with agents and emissaries scattered all over the country, forming an organization that can outwatch Argus with his hundred eyes, and outwork Briareus with his hundred hands. Instinct with one purpose, and that to secure legislation favorable to its own interests, "it has a list of local political leaders of every organized and recognized party. This list is so arranged that the dominant politics in each county and congressional district are indicated, as well as the political affiliations of each member." It, therefore, knows no party. It affiliates with any, whatever may be its principles, provided their own selfish ends can be furthered. As was Jay Gould, they are Democrats in Democratic states and Republicans in Republican states. All parties look alike to them when seeking aid and influence in securing the enactment of laws which will give them the monopoly they seek.
We will not do the medical profession of the country or the members of the American Medical Association the injustice to believe that they are entirely responsible for the conduct of the clique in Chicago, or that as a whole they endorse their high handed actions. It may be that it is simply a case of a few men, dressed in a little brief authority, getting beside themselves. But it is a maxim of law that qui facit per alium facit per se—in other words, that a man is responsible for the deeds of his agents acting within the sphere of their authority, and, therefore, it seems to us, that the good of the medical profession, of the science of medicine, of the public at large, and of the American Medical Association, itself, would be best subserved, if some restraint were put upon those now directing the affairs of the great association; or, better, that they should be summarily removed from office, and that wiser and better men be put in their places. In the meantime, it 1 is the duty of every good citizen to be on the lookout for I the legislative schemes of these conspirators, in order that none of them may, by inadvertance or otherwise. slip through Congress or our State Legislatures.