Today we have part two of a guest post written by David Herzberg, Ph.D., who will present “The Other Drug War: Prescription Drug Abuse and Race in 20th-Century America” on Tuesday, October 22. Read part one here and part three here.
This story of medical journal advertising is typically cast as what historians call a “declension narrative,” a tale whose main arc tracks a decline from the honorable virtues of past generations to the immoral venality of today. In this telling, commerce and marketing slowly colonized the therapeutic endeavor, transforming from the noble pursuit of health into an untrustworthy, buyer-beware precinct of the larger consumer culture.
But this story can also be told very differently.
After all, there had always been advertisements in the medical journals, and subscribers had always been able to see them—they had no librarians to slice-and-dice for them. Subscribers read the articles in the context of having also seen the ads.
“For the ‘Cheater Eater.'” From JAMA, volume 207, number 11 (March 17, 1969). Click to enlarge.
What might they have drawn from the experience of flipping through the unexpurgated journals? Well, historians have had a field day analyzing the messages of particular ads or particular articles. But the overall structure of the journals also sent its own message. When subscribers flipped past the bundle of advertisements before the table of contents to the ad-free material within, they saw to their satisfaction that commerce had been carefully contained where its self-interested values would not contaminate the real work of medicine—the empirical pursuit of truth, the professional sharing of new ways to alleviate illness and suffering, etc.
And yet, as historians have repeatedly demonstrated, commerce, especially the pharmaceutical kind, had long been a powerful force in medicine. From Parke-Davis’ hyping of cocaine in the 1880s, to Smith Kline French’s careful orchestration of research on amphetamine in the 1930s and 1940s, to Carter Product’s “launching” of minor tranquilizer Miltown with a public relations campaign worthy of a Hollywood starlet, drug companies and their marketing departments are ubiquitous in the history of medicine if you look for them. Their influence was only heightened, ironically, by their loud protestations that their marketing campaigns had no influence on physicians’ therapeutic decisions—doctors, they said, were obviously far too smart and well educated to be swayed by Madison Avenue gimmickry. Few physicians were inclined to argue with such logic, and so the marketing hoopla remained paradoxically below the radar, relatively free of scrutiny or regulatory oversight.
“A sleeping pill for night squawks.” From JAMA, volume 207, number 10 (March 10, 1969). Click to enlarge.
From this perspective, we might all have breathed a sigh of relief when the 1950s rolled around and medical journals finally came clean, giving advertisements the pride of place they had long ago earned and beginning the process by which Americans would come to recognize, and grapple with, the centrality of commerce in their medical system. It is no accident that formal regulatory control of medical advertisements was finally given to the FDA less than a decade later.