A Medical Economics Web Exclusive

Flashback in Medical Economics

25 years ago: February 1976

"Despite the defiance of the American Medical Association," Medical Economics Washington Editor James A. Reynolds observed, "the real question now is not whether [physician] advertising will be permitted, but rather when, where, and what kind."

Today, a quarter century after Reynolds reported on the Federal Trade Commission’s formal complaint against organized medicine’s anti-advertising stand, it’s hard to recall when doctors didn’t tout their services in newspapers, direct-mail brochures with discount coupons, and slick cable-TV commercials. But in 1976 the resistance to advertising was wide and deep within the medical profession. (It lingers to this day among some physicians.) So Uncle Sam aimed the legal guns.

The FTC filed its complaint specifically against the AMA, the Connecticut medical association, and the New Haven county society as a means to attack the anti-advertising peer pressure brought on individual practitioners. By threatening censure and expulsion, the FTC alleged, organized medicine discouraged its members from "soliciting business, by advertising or otherwise, engaging in price competition, and otherwise engaging in competitive practices." As a result, the agency claimed, consumers were deprived of the benefits of competition, including "information pertinent to the selection of a physician."

The AMA fired back. Advertising by a doctor "is the very antithesis of professionalism," the association’s leaders declared. "We think there is enough hucksterism in this country without hucksterism in medicine. And we’re going to fight it." But a total ban on doctor advertising was bound to fail, warned lawyers who’d been through other skirmishes with the FTC. The AMA would be wiser, they said, to focus on setting guidelines for permissible ads.

How firm those guidelines should be was controversial in itself. At AMA headquarters, and those of its state and county affiliates, almost anything flashier than a very small, adjective-free announcement of a new or relocated practice was considered distasteful, a lapse of professional ethics. "The FTC, in contrast, thinks physician advertising should go well beyond bare-bones announcements," Medical Economics reported. "Spokesmen envision ads that would give a doctor’s specialty, describe his training and qualifications, set forth his hospital affiliations, tell what honors he’s received, and disclose his policy on special services such as house calls."

At least one doctor who’d been at the top rung of the AMA hierarchy agreed. Former president Russell B. Roth cautioned that if the association maintained its rigid position, it would lose any chance to control advertising within the medical profession. Better to set clear standards for ads, he said, than to insist on no ads of any kind. "I hope it will remain unethical, if not actually illegal, for a doctor to beat the bushes for patients," Roth added.

By the 1980s, in the face of the FTC assault, organized medicine had grudgingly yielded its resistance to advertising. Practice marketing has become a fixture in the doctor business, and ads–some crude, some sophisticated–are accepted as integral parts of marketing strategy.

And by now, in parts of the country where doctor competition is fiercest, the bushes are being beaten nearly flat.

50 years ago: February 1951

Eight months after the shooting started in Korea, four articles in the same issue of Medical Economics showed how the war had crowded into the minds of our readers–and our staff:

• "Doctor Draft Digs Deeper" noted that the call-up of physicians was escalating well beyond the numbers forecast immediately after North Korea invaded its southern neighbor. Physicians in America’s active military reserves had already been recalled into service, and the US had begun drafting doctors who had no military ties.

How many would be needed? The Armed Forces Medical Policy Council wouldn’t say. But at the rate physicians were being drafted at the end of 1950, the magazine projected, one in every seven doctors under age 50 would be in uniform by July ’52.

• A second article reflected the fear in this country that the Korean conflict would trigger global nuclear war. "Medical Men vs The Bomb" painted a disturbing, hypothetical scenario of New York City doctors struggling to care for untold thousands of victims after an atomic bomb exploded above lower Manhattan.

Physician survivors labored amid chaos to save lives and ease the pain of the dying. Major hospitals, except those far from ground zero, had been reduced to cinders. Fires raged out of control across the city. Except for two-way radios, all communications were knocked out. Schools, churches, office buildings, and other still-standing structures became emergency medical facilities.

By the fourth day, health professionals and volunteers working without sleep were confronted with waves of new victims–those in whom deadly radiation sickness had emerged. This nightmare had been anticipated by civil defense authorities: Whole blood, antibiotics, and what the article’s author called only "special drugs" had been flown in from around the country.

Total casualties–70,000 dead, 65,000 injured–were lower than expected. Much of the credit went to New York’s doctors, nurses, and the nonprofessionals who aided them. "Surprising results can be achieved even in desperate cases," said the city’s medical defense director, "provided skillful fracture, burn, and anti-shock therapy is begun early."

• Meanwhile, two articles addressed pocketbook concerns on the home front. "Hedge Your Affairs Against War" passed on tidbits such as these: 1) "Inflation almost certainly will pick up momentum. Pick investments that will rise in price as it progresses. Real estate and common stock are the best hedges." 2) "Aircraft stocks are apt to do no better over the long pull than some less-direct beneficiaries of war orders, like steel and textiles."

"Can You Collect for War Damage?" speculated that Uncle Sam might revive the War Damage Corporation, an agency created after World War II to reimburse those who’d sustained major financial losses. What if your office were destroyed in an enemy air assault? What if the attack also cost you valuable equipment and supplies? And (horrors!) what if a bomb blew up the safe containing all your stock certificates? Fear not, said some insurance experts; the WDC would make you whole again.

As things turned out, of course, the problem was moot. No enemy bombers appeared in US skies.

75 years ago: February 1926

For a doctor, success involves much more than affluence, wrote a Wisconsin practitioner in "The Philosophy of a Physician’s Life."

Maurice Duane Bird defined success for a doctor as "making good professionally, elevating our surroundings, associating ourselves for the better of our commonwealth." If a physician can help his community become happier, healthier, and beautified, he will achieve success, Bird contended.

What, specifically, must the doctor do? Bird’s advice:

• "Have a clean and beautiful lawn about your home." And see to it that the home itself is "pleasing to the eye"–but not expensive.

• "Keep your office clean and in order."A pristine desk, to Bird, was "an earmark of character." And "clean" meant "no unanswered letters, no journals unread, no junk to annoy or distract the mind."

• "Take good care of your health," but be sure to "carry all life insurance you can afford."

• Pay all bills, preferably in cash, the same day the statement arrives." "Ever be jealous of your credit," he urged, "and the world is yours!"

• To polish your financial image, Bird suggested, buy some stock in the local bank, "so as to feel at home there and develop the friendship of its personnel."

• "Always be punctual. Never be late with appointments, office hours, hospital work, operations, consultations, consultations, or meals." Set this example, Bird insisted, and patients will follow suit by paying their bills promptly.

• If someone doesn’t pay promptly, however, "do not be small or miserly." Never charge interest on an overdue bill, Bird cautioned. That’s what the bank does (and you’re a stockholder, remember).

Bird emphasized the value of close ties with the bank. "You will be guided by the best businessmen in your community. Your collections, investments, and business acumen will be brightened and strenghtened, and you will be on easy street."

You will also "be of real value to your community,"the Wisconsin GP concluded. "Life is not unlike a mirror; it will return only what it receives."

–James D. Hendricks
Executive Editor

James Hendricks. Flashback in Medical Economics.

Medical Economics

2001;3.