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by this Bureau. Through this Bureau the American Medical Association is able to bring great influence to bear on the pharmaceutical advertiser, and how this influence car be used, if wielded by unscrupulous persons, is easily seen. It is an influence, whatever else may be said of it, that is writing the epitaph of independent medical journalism, by centralizing pharmaceutical advertising in the "Journal of the American Medical Association" and the subsidized State Journals and by taking it from the independent journals. At the meeting of the Association, at Atlantic City, in June, 1907, it was urged that members of the Association give their support to only those journals which do not carry the advertisements of articles "rejected" by the Council.

Where Does the Money Go?

The net profit of the "Journal of the American Medical Association" for 1906 was $55,000, and the Association's assets were $269,661.89 in excess of its liabilities. In 1906 the Association's receipts were $31,915.50 more than its expenditures for all purposes, that sum representing the net profit for the year. The assets are controlled, as is everything else in the American Medical Association, by the "machine." The financial affairs are secrets of which no detailed statement of receipts and expenditures is made, despite the efforts of a few members to learn where the money comes from and where it goes. No one knows except the "machine" what it costs to reprint and circulate the scurrilous articles printed in "Collier's," or what it costs to promote the "Ladies' Home Journal" Bill in various State Legislaturès. (See Chapter XV.)

That the methods of those in power are beginning to be questioned is shown by the following editorial from the "New York Medical Journal,” relating to the address of the President at the last meeting of the American Medical Association:

With the felicity of diction which we have long been accustomed to find in Dr. Bryant's utterances, he dealt in his presidential address before the American Medical Association at the fifty-eighth annual meeting, held in Atlantic City this week, with some matters that are deserving of serious thought by those who have the welfare of the Association at heart. The address was entitled "The American Medical Association, Its Aims and Interests." It was a dignified and wise address, showing more concern for the achievement of the original purposes of the Association than for the success of its more or less commercial undertakings.

"In the founding of the Association," said Dr. Bryant, "there was but one significant object in view, namely, the promotion of the science and art of medicine. The measures announced at the time as necessary to this end, so far as the Association could hope to contribute to its accomplishment, were the uniting into one compact organization of the medical profession of the United States, the promotion of friendly intercourse among individual physicians, the safeguarding of the material interests of the medical profession, efforts to procure advanced standards of medical education, furtherance of the enactment and enforcement of just medical laws, the enlightenment of the people in matters of hygiene, and the presentation to the world of the practical accomplishments of scientific medicine."

The purposes thus set forth were certainly of the worthiest. The fact should not be overlooked that they were calculated to promote, not the aggrandizement of the Association itself or the interests of those only who were or might become members, but the welfare of the entire medical profession and that of the whole world. There was nothing to indicate that the Association or any controlling set of men within it would ever seek to lay down rules of conduct for members of the medical profession, to go into the book publishing business beyond the publication of the Association's own transactions, or to endeavor to cripple medical societies and medical journals which might venture to dissent from any oligarchical dicta put forth under the Association's authority. For several years the purposes originally proclaimed, and those only, were kept steadily in view, but at subsequent times there crept in manifestations of an itching to put the entire profession under the control of the superfine consciences belonging exclusively to a few choice spirits. Dr. Bryant did not speak openly of these matters, but he gave in his address some hints which we cannot interpret otherwise than as indicating that he had in mind the perils that are likely to come about from any radical deviation from the course of action originally proclaimed by the Association. In another editorial the same publication says:

000.

It appears from the treasurer's report that the assets of the Association amount to about a quarter of a million dollars and that last year its journal made a profit of $55,What should be done with all this money? Should it go on accumulating, possibly to tempt future officials to acts of dishonesty? Some of its servants are now drawing high pay, though not too high, we are willing to concede; yet the coffers are getting more and more swollen. It is difficult to conceive of any great drain upon the treasury as likely to arise under the present methods of management, and equally difficult to appreciate the need of allowing the funds to go on increasing enormously without being

applied to some purpose consonant with the attainment of the Association's origina. objects.

The British Medical Association, a smaller and less wealthy organization, as we understand it, makes considerable "scientific grants" of money-grants made for the purpose of enabling men to enter upon systematic research in medicine. We are unable to understand why the American Medical Association should not do more than it does of the same thing. We should say that it might well appropriate $50,000 a year to such undertakings. They would make for the advancement of medical science which certainly is not promoted in the least by most of the Association's enterprises. The Association labors for many noble purposes and accomplishes a goodly proportion of them, but it does not in any great measure devote its funds to them.

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The accumulation of a vast fund might be desirable in the face of contingent liabilities, such as ever confront insurance companies and savings banks, but an organization like the American Medical Association has surely little, if anything, of that sort to make ready for. It ought not, therefore, in our opinion, to go on building up a tremendous capital. And under the circumstances it is petty that the Association should plume itself on having this year, for the first time in its history, paid all the expenses of the annual meeting -save for the entertainment of the ladies, which has still been left to the local profession.

The American Medical Association's policy is not pleasing to all physicians, as is shown by the fact that over 2,000 allowed their membership to lapse in 1906; but, so active are the organizers and field representatives, that this loss was overcome and a crop of novitiates taken in to fill the ranks, and the total membership of all classes is about 65,000, swayed and controlled by perhaps a dozen men.

CHAPTER XIV.

"LEGISLATIVE SCHEMES OF THE A. M. A.”

Why Doctors Want to Prevent Sale of "Patent Medicines"-Dr. Wood's Objection-"Journal of American Medical Association" Advises Against "Original Packages"-"Altruism" of the "Medical Mirror"-The "Medical Times" Figures Out Doctor's Profits-New Treason Law Demanded-Are The Doctors Above Criticism?

The "National Druggist" of St. Louis, in 1906, published under the above title an article which was widely read and from which the following extracts are taken:

"To begin with," says the "National Druggist," "we will quote from the 'Journal of the Association' itself, which is the source of inspiration for all the smaller associations and other subservient organs scattered throughout the country. The 'Journal,' with its income of a quarter of a million of dollars a year, in its issue of May 6, 1905, urges physicians not even to use one of these 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 then 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 bearings 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 Americal 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.

"Out of the Doctors' Pockets."

"Dr. Horatio C. Wood, Jr., one of the leaders in the present crusade, in 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, 1905, 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 doctor's 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 ten-cent lunches in the saloons, go unshaven and with shiny clothes on their backs. * * * But, Allah be 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.

Where the Shoe Pinches.

"The 'Medical Times,' April, 1905, page 117, in a leading editorial on proprietary medicine, says:

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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, self-abnegation and the like, becomes cheap and nauseating, * ** It appears to us that such buncombe should give place to homely common sense.

*

"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 for 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 cold-hearted brutality

"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 arranged 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:

A New Treason Law Demanded.

It is one thing to discuss debatable theories and to expose dishonesty wherever found, but the events of the epidemic cannot by any artifice be twisted into any

excuse for this New Orleans paper.

The time is close at hand for the * * * creation by statute of a new variety of treason. If it be treason in time of war for 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 from 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.

Are They Above Criticism?

"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!"

CHAPTER XV.

"COLLIER'S AND THE AMERICAN MEDICAL ASSOCIATION.

A Commercial Alliance-Doctors Systematically "Worked" by "Collier's" Subscription Book Peddlers-A. M. A. Reprints Articles from "Collier's and Undertakes Circulation of Them.

That an organization such as the American Medical Association is supposed to be should enter into a commercial alliance with an organ such as "Collier's" is known to be is almost incomprehensible. It is probable that but few members of the Association realize how close this relationship is; yet most of them will remember how, after "Collier's" had been sufficiently boomed in the "Journal of the American Medical Association" and its subsidiary journals, they were systematically worked, individually, by "Collier's" premium book peddlers and how the articles on "patent medicines" were mentioned as the special reason why every doctor should become a subscriber. This systematic canvass of doctors' offices showed conclusively that the attack on "patent medicines" was largely a circulation scheme whereby it was hoped to secure the subscription of, and unload a set of books upon a great majority of the doctors in the United States; and, in aid of this scheme, the clique controlling the American Medical Association was enlisted.

Since the Association has reprinted in book form, from its own presses, the "patent medicine" articles which appeared in "Collier's" and has undertaken to circulate them— lies, libels, and all, a messenger, sent to the office of "Collier's" in New York for a copy of the articles in book form, returned with the information that all copyrights, plates, etc., had been turned over to the American Medical Association. A letter, addressed to "Collier's" brought the information that the American Medical Association was distributing the reprints and also brought a card bearing the address: "American Medical Association, 103 Dearborn Avenue, Chicago," the card being an advertisement of the articles which had appeared in "Collier's."

This reply from "Collier's" is reproduced, in facimile, on the following page, with identification marks erased in order that the individual to whom the letter was addressed may be saved from personal abuse by "Collier's". An order sent to the

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