THE GERMAN COUNCIL ON PHARMACY AND CHEMISTRY
At the meeting of the German Congress for Internal Medicine in 1911, a German council on pharmacy and chemistry, Die Arzneimittelkommission des Kongresses für innere Medizin, was organized, with purposes similar to those for which the Council on Pharmacy and Chemistry of the American Medical Association was created. As practically nothing has been done to restrict the advertising of proprietaries in Germany, the task of the commission was tremendous. Its work has been noted in The Journal from time to time.[150] A review of what has been done up to the present is given by Heubner,[151] and indicates some differences between conditions in Germany and this country. The members of the commission found confronting them the same evils that met the early efforts of the American council, namely, dominant proprietary interests, a subservient and financially interested medical press and an indifferent profession. Moreover, the pecuniary interest of the editors of German medical journals in the profits of advertising seems to be more direct and more important than in America. The German commission, in Heubner’s opinion, was placed at a disadvantage compared with the American council from the first. Funds for investigation were lacking, and the commission had no journal in which its objects could be presented to the medical profession. At the beginning of its work the commission established rules very similar to those of the American Council on Pharmacy and Chemistry. It listed the articles advertised in German medical journals in three groups: (1) those which conformed to the rules of the commission in the method of advertising; (2) those which violated the rules, and (3) those whose classification could not be determined. This amounted to an attack on advertising in medical journals and was undoubtedly premature. It aroused at once the antagonism not only of the proprietary interests but also of the medical press.
“The establishment of the lists of medicines encountered opposition or hindrance from three sources,” says Heubner, “first, from the pharmaceutical and chemical manufacturing interests; second, from the medical press, and third, from the medical profession itself. The ‘trade’ naturally was irritated at any attempt to interfere with ‘business,’ and brought forward a number of reasons why the procedure adopted by the commission was especially calculated to injure the ‘general welfare.’ This opposition was to be expected and might be disregarded. The extent to which the medical press was dependent on the drug trade, however, had not been foreseen. The same journals in which for many years all sorts of articles on the evils in the trade in medicines had appeared showed themselves decidedly cool or emphatically critical toward the accomplished fact of the ‘lists of remedies.’ In hastily written articles a whole series of mistakes in general and in particular were published.... One thing, however, was not explicitly stated—namely, that in any event the lists of remedies must be rejected, and for this the cogent reason was anxiety in regard to advertisements. The editors had been sufficiently warned. The Therapeutische Monatshefte, which had not submitted to the wish of a great industrial firm in another matter, was punished for this offense by the withdrawal of all its advertisements. None of the other publishers wanted to risk such a reduction in income, and none of the editors was willing to undertake the risk to the extent of a conflict with his publisher. Curiously, the idea does not seem to have arisen that if the threatened publishers had made common cause they might have freed their editors from the distressing burden of improper advertisements with scarcely any risk at all.”
Heubner believes that another motive influencing the editors was the fact that their efforts in behalf of reform, sporadic and ineffective at the best, had been replaced by the propaganda of the commission. It seems clear that the opposition from the press was due not to principle chiefly but to financial pressure. The editors, however unworthy their motives, nevertheless exerted, as in other cases, a powerful influence on public opinion. Among the medical public, opposition was encountered because many physicians were interested—sometimes financially—in one or more of the discredited remedies. The mass of the profession either were not interested or misunderstood the position of the council.
Despite the obstacles encountered and the difficulties involved, the council and the Congress of Internal Medicine have not wavered. Heubner, however, sums up the work of the council in a rather pessimistic tone, as follows:
“What are the results of the great amount of labor, self-sacrifice, hopeful courage and wasted money? Two journals pretend to be doing wonders in that they are eliminating some of the worst misstatements, distortions, obscurations and concealments of truth in the advertisements. Physicians at certain intervals receive lists of preparations, the manufacturers of which as a rule do not need to pay any attention to the council because their dealings are directly with the public, because their advertisements are usually made to physicians by word of mouth, or their preparations have already a sufficient reputation—no matter for what reason....
“There is little doubt that the results have not paid for the efforts expended. There is no doubt that the whole enterprise will amount to nothing more than a splash in the water if the work is not extended, just as a preliminary skirmish must remain without effect unless followed up by the main army. The main army in this case is the German medical profession. However gratifying the progressive attitude of some individuals and, in fact, of some associations, such as that of Wurtemburg, may be, the fact remains that the profession [in Germany] is not advancing but rather tends to retrograde. The support which the executive committee of the Aerztevereinsbund at first accorded to the efforts of the council was later limited. All further progress depends on the developments of the near future. Will sufficient power be given to the German medical profession after settlement with the insurance societies to permit them to follow the example of their American colleagues?
“It should be made perfectly clear,” Heubner insists, “that we are concerned with questions of importance for the standing and influence of the medical profession among the people, and, consequently, for the conditions of its future existence. But even now the consequences of the prevailing indifference to the traffic in nostrums are making themselves felt. The prevalence of self-medication, which was lately recognized by a Berlin court as the normal for ‘slight’ affections and which has already been made an argument against the extension of the compulsory prescription law, is merely a result of the great evil based on the loss of control by the medical profession of the remedies it employs. Only centralized and energetic measures on the part of the organized profession can secure a reformation of the intolerable conditions that prevail in the field of modern industry in medicine and foodstuffs. The American Medical Association and the German Arzneimittelkommission have shown that a little sacrifice and energy can secure a condition in which the medical profession becomes a powerful factor, able to dictate in the field of the trade in medicine instead of letting itself be dictated to.”—(From The Journal A. M. A., April 18, 1914.)