Supports the 'drug war' perversion of useful natural substances into concentrated poisons, lying through their teeth about Cannabis, and the massive violations of human rights for its criminal mercantilism on behalf of synthetic patentable chemical quackery
Medical Control, Medical Corruption
By Llewellyn H. Rockwell Jr.
http://www.lewrockwell.com/1970/01/lew-rockwell/medical-control-medical-corruption/
This article appeared in the June 1994 issue of
Chronicles.
The vested interests are sick over it: Americans are
beginning, just slightly, to take charge of their own health care. Such
best-sellers as the
Doctor’s Book of Home Remedies, the
Physician’s Desk Reference, and the
Merck Manual
can keep you out of the doctor’s appropriately named waiting room, or
at least help you understand what is being done to you, when an apple a
day does not work.
Who is unhappy with this increased knowledge? The
American Medical Association, which for almost 150 years has sought to
institutionalize a rip-off and to keep sick people and their families
oblivious to it. Thanks to this central committee of the medical cartel,
the number of medical schools and medical students is drastically
restricted, state licensure further obstructs the supply of doctors,
fees are largely secret and controlled across the industry, alternative
treatments and practitioners are outlawed, pharmacists and nurses are
hamstrung, and the mystique of the profession rivals the priesthood,
although priests have a somewhat lower income. Meanwhile, the customer
pays through the nose, even if he does not go to an otolaryngologist.
Medicaid and Medicare have contributed to the problem,
but the medical cartel is the original sin. Through its ability to keep
incomes high by limiting supply and outlawing competition, organized
medicine has punished its customers, although the word is never used so
as to disguise what is, after all, an economic relationship.
Hillary Clinton’s proposed merger of the medical cartel
and the state seems like a radical move, and it is. It is also the
logical next step in the partnership of government and medicine. That is
why, in addition to opposing Hillary hammer and tongs, we should
reexamine the AMA’s distortion of the medical marketplace and the very
idea of medical licensure.
Competition among providers — as with any service in a
market economy — leads to rational pricing and maximum consumer choice.
But this is exactly what the AMA has always sought to prevent. The
American Medical Association, organized in New York in 1848, advanced
two seemingly innocent propositions in its early days: that all doctors
should have a “suitable education” and that a “uniform elevated standard
of requirements for the degree of M.D. should be adopted by all medical
schools in the U.S.” These were part of the AMA’s real program, which
was openly discussed at its conventions and in the medical journals: to
secure a government-enforced medical monopoly and high incomes for
mainstream doctors.
Membership in the new organization was open only to
“regular” physicians, whose therapies were based on the “best system of
physiology and pathology, as taught in the best schools in Europe and
America.” The public had a different view, however. Official treatments
of the time, such as bloodletting and mercury poisoning, harmed and
sometimes murdered patients, causing mass outrage.
Emphatically not included among the “best” were the
homeopaths. Homeopathy, a less invasive system that still thrives in
Britain and Europe, may have done no good, but that was the worst charge
lodged against it. Homeopathy did not kill people, as Orthodox medicine
did. The homeopaths actually followed the Hippocratic injunction
“First, do not harm” and refused to worship abstract Science. As a
result, the clergy — an important interest group in 19th-century America
— sympathized with them. As the president of the New York State Medical
Society noted in 1844, “We feel severely the influence of the clergy as
operating against our collective interest.” One prominent pastor, for
example, had called the medical establishment “an expensive vampire upon
society.”
How the “regulars” came to crush the homeopaths and
other competitors, and penalize patients in the process, is a story of
deception and manipulation, of industry self-interest and state power.
The organized regulars or allopaths first set out to demonstrate that
the homeopaths were ill-educated and therefore should be shunned, but
that was difficult to substantiate because most of them were converts
from orthodox medicine.
One was William H. Holcombe. When he graduated from the
University of Pennsylvania, he worried, as he wrote in his memoirs, that
physicians “were blind men, striking in the dark at the disease or the
patient-lucky if [we] killed the malady [instead of] the man.” One day
Holcombe was called by the parents of a seriously ill child, whom
Holcombe subsequently set about to bleed. Bloodletting was considered
especially important for children, and the younger the child, the more
blood was to be drawn. But the mother clutched the baby to her breast
and cried, “The blood is the life — it shall not be taken away.” When
the benighted father agreed, Holcombe “explained to him candidly, and
with some display of professional dignity, that my opinion was worth
more than his or his wife’s.”
Holcombe left and returned the next day, expecting to
find a dead baby. Instead, the child — who had been treated by a
homeopath — was playing in the yard. Holcombe later wrote that “after
having blistered, bled, and drugged my patients for twenty-seven years, I
determined to find some more humane mode.” He was charged with
violating “medical ethics,” whose first principle was: “A physician …
should cautiously guard against whatever may injure the general
respectability of his profession.”
Eventually, homeopathy became almost as popular as
allopathy, especially in the Northeast and Midwest. Many business
leaders favored it and funded free dispensaries for the poor. This was
made possible by the free market. From the early part of the century
until 1850, state laws interfering in medical practice were gradually
repealed. The AMA was founded to reverse the trend.
New York, for example, got rid of nearly all of its
criminal legislation regarding medicine, forbidding only malpractice and
immoral conduct by physicians. As one state senator said, “The people
of this state have been bled long enough in their bodies and pockets.”
He called on them to demand medical freedom, in the tradition of “the
men of the Revolution.”
Most Americans were interested in non-orthodox treatments
and believed they should be allowed to compete in the marketplace.
Organized medicine claimed people were being fooled. But as Harris
Livermore Coulter explains in his extraordinary 1969 study of the AMA’s
founding, “People were deserting orthodox medicine … not out of
ignorance, but out of knowledge of regular practice and consequent
dislike of it.”
An 1848 AMA convention speaker laughed at the “mass of
the community” who thought there was “a wide difference” between a
physician’s “Apothecary Medicine and our native medical plants.” The
first “they regard as almost uniformly poisonous — the other, as
harmless and healthful.” He called this “an absurd idea,” although
virtually none of the official treatments of the time is still In use
and many drugs from our “native medical plants” have proven to be
effective.
Worse than absurd was the effect on doctors’ incomes.
“Quackery [i.e., unofficial treatments by unofficial practitioners]
occasions a large pecuniary loss to us,” lamented an 1846 editorial in
the New York Journal of Medicine. Quacks “too frequently triumph and
grow rich, where wiser and better men scarcely escape starvation.” To
the medical dean at the University of Michigan, the specter of free
competition was a “discouragement” to “graduates in scientific
medicine,” rendering their work “arduous and unremunerative.”
In the golden age, “the doctor could tell his patient”
anything, including, “‘gape, sinner, and swallow,”‘ wrote J.H. Nutting
in 1853. Then, with his “grave look of profound wisdom,” the doctor had a
“reputation for almost superhuman skill.” Doctors, wrote the journal of
the Massachusetts Medical Society in 1848, should be “looked upon by
the mass of mankind with a veneration almost superstitious.” Instead,
there was public contempt.
A Michigan physician reported that the profession had
“fallen so low that there are few to do it reverence. Quackery and
empiricism in diverse forms like the locusts and lice of Egypt, swarm
over our state and are eating out the very vitals and sucking the life
blood” of doctors, some of whom said they were denounced on the street
for bumping off their patients.
Organized physicians argued that popular reputation
meant nothing. In fact, claimed the journals, a good standing in the
profession usually meant a bad one with the public. At the same time
there was the complaint — echoed by cartelizers to this day — that there
were simply too many doctors. “The profession” is “crowded,” argued one
journal, with “unworthy and ignorant men” who ought to be prohibited
from practicing. The regulars also villified their opponents with such
works as Oliver Wendell Holmes’ Homeopathy and Its Kindred Delusions
(1842).
In 1849, the AMA worried that simply outlawing
competition would not override the public’s perversity. The only
long-term “remedy against Quackery, is medical Reform, by which a higher
standard of medical education shall be secured.” As part of this drive,
homeopathic physicians were expelled from state and local medical
societies, even if they were trained in official schools. The AMA
claimed that the public did not know what was good for it and that the
medical establishment must have total control.
The organization knew it needed more than persuasion to
secure a monopoly, so it also called for a national bureau of medicine
to oversee state licensing and other regulations. In those
limited-government days, however, the idea went nowhere. But in the
statist Progressive Era after the turn of the century, anticompetitive
measures became respectable, and the AMA renewed its drive for a cartel,
spurred on by the popularity of self-medication and the increasing
number of medical schools and doctors. (In 1902, an AMA study decried
the competition that had lowered physicians’ incomes.)
The number of medical schools had increased from 90 in
1880 to 154 in 1903. As an official AMA history by James Gordon Burrow
puts it, the “frightening competition” showed a need for “education
reform,” i.e., cartelization. The state legislatures showed little
interest in more restrictionist laws, so the AMA appointed the secretary
of the Kentucky State Board of Health to rouse the profession to lobby.
Joseph N. McCormack spent a decade in agitprop among the
doctors of more than 2,000 cities and towns, inspiring them with such
speeches as “The Danger to the Public From an Unorganized and Underpaid
Medical Profession.” Like medical ethicists before and since, he
denounced advertising (letting customers know services and prices in
advance) and quackery (unapproved competition). Join our union, he said,
and we will raise your pay. By 1910, about 70,000 doctors belonged to
the AMA, an eight-fold increase over the previous decade.
To help bring about a higher-paid profession, the AMA in
1904 created the Council on Medical Education, which sought to shut
down more than half the existing medical schools by rating them on a
scale of A to C. In cooperation with state medical boards composed of
what Arthur Dean Boran, head of the council, called the “right sort of
men,” the AMA succeeded in cutting the number of schools to 131 by 1910,
from a high of 166.
Then the council’s secretary N.P. Colwell helped plan
(and some say write) the famous 1910 report by Abraham Flexner. Flexner,
the owner of a bankrupt prep school, had the good fortune to have a
brother, Simon, who was director of the Rockefeller Institute for
Medical Research. At his brother’s suggestion, Abraham Flexner was hired
by the Rockefeller-allied Carnegie Foundation so that the report would
not be seen as a Rockefeller initiative. And Carnegie, whose main goal
was to “rationalize” higher education, that is, replace religion with
science, saw the AMA cartelization drive as useful. Claiming to have
investigated nearly every school in the country, Flexner rated them on
suitability. Schools he praised received lush grants from the
Rockefeller and associated foundations, and almost all the medical
schools he condemned were shut down, especially the “commercial”
institutions. AMA-dominated state medical boards ruled that in order to
practice medicine, a doctor had to graduate from an approved school.
Post-Flexner, a school could not be approved if it taught alternative
therapies, didn’t restrict the number of students, or made profits based
on student fees.
Why the opposition to for-profit schools? If an
institution were supported by student fees rather than philanthropic
donations, it could be independent of the foundations. The Rockefeller
family had invested heavily in allopathic drug companies and wanted
doctors to use their products.
The Flexner Report was more than an attack on free
competition funded by special interests. It was also a fraud. For
example, Flexner claimed to have thoroughly investigated 69 schools in
90 days, and he sent prepublication copies of his report to the favored
schools for their revisions. Homeopaths noted that his authority derived
solely “from an unlimited access to the pocketbook of a millionaire.”
Homeopaths did not use synthetic drugs, of course. John E. Churchill,
president of the Board of Education of New York, called the report a
“menace to the freedom of teaching.” Years later, Flexner admitted that
he knew nothing about medical education. But he did not need to in order
to serve his employers’ purposes.
Flexner’s attack, stepped up by the AMA’s Council on
Medical Education and its state medical boards, closed 25 schools in
three years, with more over the years to come, and cut the number of
students attending the remaining schools in half. All non-mainstream
practitioners were targeted. For example, from the early part of the
century, consumers preferred optometrists to ophthalmologists on grounds
of both service and price. Yet the AMA derided the optometrists as
quacks, and in every state, the AMA-dominated medical boards imposed
restrictions on these and other “sectarian” practitioners when they
could not outlaw them entirely.
Homeopathy still had a remnant of about 13,000
practitioners, supported by a fiercely loyal customer base, but decades
of well-financed attacks had taken their toll. The battle-weary
homeopaths eventually gave in, conceding major parts of their doctrine,
but the AMA was not satisfied with anything less than total victory, and
today, American homeopaths practice mostly underground.
With its monopoly, the AMA sought to fix prices. Early
on, the AMA had come to the conclusion that it was “unethical” for the
consumer to have any say over what he paid. Common prices were
transmuted into professional “fees,” and the AMA sought to make them
uniform across the profession. Lowering fees and advertising them were
the worst violations of medical ethics and were made illegal. When fees
were raised across the board, as they frequently could be with decreased
competition, it was done in secret.
But organized medicine still feared reporters. In
Illinois in 1906, the publication of secret fee increases nearly incited
public violence. The secretary of the Illinois Medical Society, N.L.
Barker, admonished his fellow physicians to keep their higher
“fee-bills” secret, “for the people will not appreciate what was
intended for kindness and justice.” To collect the higher fees, the AMA
recommended that state-level medical societies develop formal systems.
If a patient had not paid the full amount, especially out of
dissatisfaction with the treatment, his name would go on a blacklist and
he would be forbidden all future treatment by doctors until he had paid
up and shut up.
The AMA, in its constant quest for higher incomes
through lower competition, also battled churches and other charities
that gave free medical care to the poor. Through lobbying, it attempted
to stamp out what it called “indiscriminate medical charity.” A model
1899 law in New York put the control of all free health care under a
State Board of Charities dominated by the AMA. To diminish the amount of
free care, the board imposed fines and even jail terms on anyone giving
treatment without first getting the patient’s address and checking on
his financial status.
Then there was the problem of pharmacists selling drugs without a
doctor’s prescription. This was denounced as “therapeutic nihilism” and
the American Pharmaceutical Association, controlled by the AMA, tried to
stamp out the low-cost, in-demand practice. In nearly every state, the
AMA secured laws that made it illegal for patients to seek treatment
from a pharmacist. But still common were pharmacists who refilled
prescriptions at customer request. The AMA lobbied to make this illegal,
too, but most state legislatures wouldn’t go along with this because of
constituent pressure. The AMA got its way through the federal
government, of course.
There were other threats that also had to be put down:
“nostrums,” treatments that did not require a visit to the doctor, and
midwives, who had better results than doctors. Also a danger was
“contracting out,” a company practice of employing physicians to provide
care for its workers. This was “unethical,” said the AMA, and should be
illegal. Fraternal organizations that contracted out for their members
were put out of business with legislated price controls, and hospitals —
whose accreditation the AMA controlled — were pressured to refuse
admittance to patients of contracting-out doctors.
By the end of the Progressive Era, the orthodox
profession as led by the AMA had triumphed over all of its competitors.
Through the use of government power, it had come to control education,
licensure, treatment, and price. Later it out-competed fraternal medical
insurance with the state-privileged and subsidized Blue Cross and Blue
Shield. The AMA-dominated Blues, in addition to other benefits, gave us
the egalitarian notion of “community rating,” under which everyone pays
the same price no matter what his condition.
AMA control remains much the same, and as a result, even
incompetent doctors are guaranteed high incomes. In law, a profession
with much freer entry, some lawyers get rich, others make middle
incomes, and others have to go into another line of work. But thanks to
almost a century and a half of AMA statism, even terrible doctors get
lavish incomes.
The monopoly also allows anti-customer practices to go
unpunished. For example, doctors routinely schedule appointments too
closely together so as to keep their waiting rooms full, for prestige
and marketing reasons. With little competition, they can get away with
it, and advertising on-time service would be “unethical.” The next time
you have to wait 45 minutes amid six-month-old People magazines, thank
the AMA.
Now, if Hillary gets her way, licensing will become even
more abusive. Her Health Security Act mandates racial quotas for
medical students and faculties, as well as for practicing physicians in
the health alliances. This is the wits’ end of licensing, which began as
an effort by the regulars to weed out the competition and will now
force on us the spectacularly inept, scalpels in hand.
Real reform would remove the AMA’s grip on the
marketplace and subject the entire industry to competition. Until then,
stock up on home medical books.
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Has Hillary Clinton or any other major name politician ever questioned the AMA?
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