From 1880 to 1940 medical professionalism was supported by the State Medical Societies. Thereafter this very strict injunction was eased somewhat and physicians were allowed to site their name, address and specialty in telephone directories and similar publications mainly as a means of demonstrating their professionalism in contradistinction to midwives and other health professionals. Nevertheless it was maintained that all practitioners were equal. They felt that the fact that a person was a physician guaranteed a code of conduct that insured good medical practice and that other advertising was not required. This was reinforced by the practice of consultation between the generalist an the specialist.
After the Second World War the public and particularly the Federal Trade Commission encroached upon these philosophies because it was felt that some quality assurance was required and that competition was necessary. In the inter- period the American Medical Association (AMA) had waged a campaign against patent medicines and in 1938 the Federal Drug Administration introduced the regulation of labels for medication. After the war the AMA also objected for physicians endorsing particular medications even those produced by ethical companies. Nevertheless, the pharmaceutical industry attempted and did obtain the support of physicians and particularly tobacco companies obtained the support of doctors to smoke particular brands of cigarettes and that these were milder and better than other cigarettes.
Then the Federal Trade Commission, only because of the increasing cost of health care, participated in changes of competition between physicians and medicine between 1945 and 1975 became big business. The AMA could not reconcile the idealism of physicians and that of business. There was a critique of the AMA of paternalism and a critique that physicians treated illness rather than providing health. The AMA failed to promote preventive care especially in connection with smoking. Then the active consumer movement of the 1960s and Ralph Nader critiqued the medical professions and felt that doctors should compete against each other based on quality of care. Thus came into being the movement of Consumer Rights and the concept of the health consumer. This replaced the authoritative model of the physician.
By 1978 these movements assumed that the medical professional was protective of its own interests. Therefore the Federal Trade Commission wanted medical practice to be based on economic needs and allow informed decision making. Medicine was not being exposed to market forces and it was felt that if it were the cost of medical care would decrease.
Advertising was therefore permitted particularly with infertility medicine and laser surgery. Nevertheless the taboo among physicians against blatant advertising remains.
Then came hospital marketing of physicians and nursing care and finally direct consumer advertisements. This applies particularly to drug companies advertising their own drugs such that now at the change of the century one in five patients asks for the specific drug that he/she has seen advertised on the radio or television and 50% of these patients, in fact, obtain the drug requested. It is not at all certain whether this practice is helpful to good medical care.
Dr. Tomes thought that the disadvantages of this system significantly outweigh the advantages. She stated that new products produce a saturation of the market, which then declines and then there is increased advertising again. Nevertheless, manufacturers continue to advertise for fear of losing market share. A huge amount of money, amounting to billions of dollars, is spent on such advertising.
From all this it appears that consumer empowerment has not, in fact, been the best for patients' rights. The objective of cost containment rather than improved quality care has not been a successful public policy. There is no easy distinction between advertising and consumer advice. Preventive health care is confused with consumer advertising. She thought there was presently a chance to regain the moral high ground and that the AMA has begun to critique these market forces. Professionals, teachers, and all physicians need to think critically of commercialism and need to think of medical consumerism in a more broad way.