“One would suppose,” says this lay journal, “that medicinal preparations which did not win the approval of scientific medicine would not be used by any physician, but the contrary is the case. In fact, those new medicinal preparations or old ones with new names that flood the market far surpass the actual demand according to the judgment of all authorities. The impartial advisers in this field, practitioners and members of medical faculties, demand, as a matter of public welfare that this overproduction should be regulated in the interests of the sick, the consumers; but, unfortunately, a medical man, like any one else, is impressed by the suggestion from advertising done on a large scale.”
The movement for reform, Wohlfahrt und Wirtschaft goes on to explain, is not exclusively a medical one. It is a part of the reaction of “economic common sense” against a too individualistic commercial system which leads to overproduction. In other words, it is a reaction against the system of making things because they can be sold rather than because they are needed. The interests of producers need to be harmonized with those of consumers, not merely in the drug trade alone, but throughout the commercial world. Wohlfahrt und Wirtschaft quotes with unqualified approval the ArzneimittelKommission’s statement of its position: An industry which serves the science of healing must be guided by that science. (Eine Industrie die der Heilwissenschaft dient, hat sich nach der Heilwissenschaft zu richten.)
The movement for reform in Germany has apparently gathered sufficient impetus among the laity to go on of its own momentum, even though, with one exception, German medical journals, reluctant to lose the advertising of drug houses by publishing criticisms of their wares, have become lukewarm, if not antagonistic, to the efforts of the ArzneimittelKommission. The one exception is the Therapeutische Monatshefte, which, in its May issue, quotes in full the editorial just referred to and makes the following comment: “These lines reveal such intimate knowledge and correct judgment of existing conditions that the suggestions advanced in regard to possible reforms deserve serious consideration. For us physicians the editorial is important in that it recognizes that the efforts of the profession to accomplish the reforms aimed at are rational and beneficial from the standpoint of general economics and the public welfare.”—(From The Journal A. M. A., June 13, 1914.)
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....