=THE BUGBEAR OF ETHICS=
One of the first spooks with which the young practitioner will be
confronted is the bugbear of Ethics—don’t overlook the big E. It will be
in front of him on graduation day, his preceptor will dangle it before
his eyes as he hands him his papers, and it will be continually bobbing
up after he has hung out his shingle.
Now ethics in its place is a good thing. It is especially essential in
the medical profession in which, without a due regard for the
proprieties, many men would be tempted to go astray. And this temptation
is by no means slight at times. But there is such a thing as overdoing
the ethical proposition. It becomes monotonously annoying for a man to
have his every movement watched and judged from the ethical standpoint
by a lot of self-constituted censors. The average physician, in his
bearing toward his younger brother does not ask himself the old
question, “Am I my brother’s keeper?” Not at all. On the contrary the
worst of it is he assumes an opposite attitude and by his actions
asserts “I am my brother’s keeper.”
In a way these men assume the right to dog and spy upon the movements of
other physicians on the plea that they are doing it for the benefit of
the profession—to see that the great Code of Ethics is not violated.
What they are really after, nine times out of ten, is to make sure that
the young, progressive practitioner who has the tact and ability to
build up a good-paying practice does not encroach upon their preserves.
This is bad enough, but there is a worse side. In nearly every instance
those who howl the loudest about violations of the code, are gross
offenders themselves. This is a bold assertion, but the proof will be
furnished later on.
One of the things specially cited as an unpardonable violation of ethics
is the courting of newspaper and similar publicity.
“My dear boy,” one of these old-time offenders will say, “you must not
allow your name to appear so frequently in print. It is undignified and
unethical. Our profession is one of mighty dignity and responsibility,
and you owe it to yourself and your brother physicians to avoid anything
which tends to lower or debase it. I know it is only human to seek
notoriety of this kind, and that it is valuable so far as the mere
getting of money goes, but we must be actuated by higher, nobler
motives.”
It is practically a certainty—with rare exception—that the man who gives
this advice, is bending every energy, and using every possible means to
secure the same kind of publicity. He knows that fame and wealth come
from keeping one’s name constantly before the public.
In every large city we will find physicians of wealth and fame, of whose
every movement the newspapers seem to have information in advance. How
do they get it? Let us analyze the conditions.
Under his professional obligation Dr. Soakum is bound to observe and
live up to the code of ethics. He prates loud and often about the
beauties of an ethical life, and the uninitiated might well suppose that
his was a model existence in this respect. But, is it not a trifle
strange that whenever Dr. Soakum, owing to his great skill and fame, is
called out of town to attend some prominent personage in another city
the newspapermen know he has been summoned. More than this, they know
where he is going, whom he is going to see, and what train he is going
on. Strange, is it not?
It is no uncommon occurrence to read items like the following in the
daily press:
Dr. Soakum, the distinguished specialist in chronic disorders,
left for San Francisco yesterday, having been summoned by wire
to attend the Hon. Million Moneybags, who is seriously ill with
chronic nephritis. The patient, whose disability at this time is
of grave import to a number of large business transactions, has
been under the care of a number of famous physicians, but his
great confidence in the skill of Dr. Soakum led to the hasty
summoning of the latter.
Dr. Soakum, who was seen by our reporter just as he was boarding
the Overland limited confirmed the report. He added that the
time of his stay was uncertain, as the case is a most important
one, and may demand his undivided attention for some weeks.
During his absence Dr. Soakum’s vast practice will be looked
after by his associate, Dr. Bleedum. He added that he was both
surprised and annoyed to think the news had leaked out.
Surprised! Annoyed! Not on your life. This was only a bit of stage play,
of dramatic action, on the part of Dr. Soakum. Real surprise, real
annoyance and real anger would have resulted only from the failure of
the reporter to appear after the careful arrangements which had been
made to ensure his attendance.
How often have many of us read items like the following in the daily
press:
At last there is hope for the consumptive. Dr. Killem, the
eminent specialist, whose success in the treatment of
tuberculosis has aroused wide interest in the medical
profession, has made public the details of his treatment by
means of which such wonderful results have been obtained.
“I would have done this long ago,” said Dr. Killem to a reporter
for the _Morning Howl_, yesterday, “were it not that I desired
to be absolutely certain as to the permanent efficacy of the
treatment. Now that there is no longer room for doubt on this
point I feel at liberty to act.
“The essential feature in my method is,”——
And Dr. Killem goes on to give what he calls a professional statement,
so involved and beclouded with high-sounding terms that the poor
reporter makes a sorry mess of this part of his story.
Strange as it may seem this is just what Dr. Killem wants. He knows his
treatment will not stand a scientific analysis by competent men, and he
avoids this by intentionally leading the reporter to misquote. And then
it gives him an opportunity to write a letter of protest to the
newspaper and thus obtain more publicity.
“I’m chagrined,” Dr. Killem will say to his professional brethren. “That
reporter for the _Morning Howl_ has made an ass of me, but I suppose
there is no redress. I gave him a few, a very few facts, out of
kindness, and he has distorted them and made me ridiculous.”
And all the time Dr. Killem is swelling with pride. He has “put another
one over” on the press, and obtained a lot of valuable publicity that he
could not have bought outright. Besides he would not think of doing such
a thing as to pay for advertising—it would be unethical.
How do you suppose the newspapers get hold of such items? Reporters are
a pretty smart lot of men with noses keenly trained on the scent of
news. But none of them, so far as known, possesses the gift of being
able to tell in advance what is going to occur at a given time. Smart as
they are it would be out of the question for them to know that Dr.
Soakum had been called out of town, or that Dr. Killem had interesting
information to impart to the public, unless they got tips to this
effect, and these tips are just exactly what they get.
None of these physicians have press agents. Perish the thought. That
would be decidedly unethical, and too clumsily convictive. No siree.
They are too smart for that. Most of them, however, especially those who
work the press continually, have private secretaries. The private
secretary work is light, and is attended to by stenographers and
book-keepers, but the title affords a handy cloak for disguising the
press agent. Ostensibly engaged as private secretaries the men who fill
these positions know full well that their one and only duty is to
“boost” the professional prowess of their employers; to keep them
constantly before the public.
Frequently this work is done by men who have no open, direct connection
with the physicians who employ them; are not even seen around their
offices. This is the latest dodge, and is becoming more and more
general. It has one decided advantage in the fact that it is impossible
to trace any collusion between the party who gives out the news, and the
party who is benefited by the publication. It also has a further
advantage. It enables the physician to put on an air of surprise, should
he be questioned by a brother doctor, and say:
“Smith. Who is he? He is not on my office staff, and is certainly
assuming a lot when he pretends to speak for me.”
All of these press agents work on the same lines. They know the avidity
with which city editors grab for news, particularly if it concerns
prominent people. When the occasion arises they get into communication
with some city editor, generally by phone, and a conversation something
like the following ensues:
“Hello, that you Brown? This is Jones. Yes, the same, old man. Thanks.
I’ve just got onto something that looks like a good tip, and I thought
you would like to have it. Dr. Soakum has been called to San Francisco
to attend old Moneybags, the trust magnate. If the old chap should die
it would raise Old Ned in the stock market. I understand that Soakum
goes this afternoon on the U. P. limited. Oh, don’t mention it. I’m glad
to be able to give you the tip. Hope you’ll be able to get a story out
of it.”
Jones, the press agent, does not, of course, tell his city editor friend
that there’s $25 in for him (Jones) if the story is printed. He’s too
smart for that. So far as the city editor knows Jones is simply trying
to do him a favor in a news way. The press agent is also smart in
another direction—he does not call on the same city editor too often. It
might arouse suspicion.
In nearly every city of any size there are a number of newspapers. Jones
works them in rotation, so far as Dr. Soakum is concerned. First it is
the _Morning Howl_, then the _Daily Screech_, next the _Evening Whirl_,
and so on. Between the Dr. Soakum stories Jones works in items about
other people, for the modern press agent is an enterprising chap who
represents a number of clients all eager for publicity. A good press
agent can look after the interests of a physician, a lawyer, an actor,
and a promoter at all the same time, and not overwork himself. It’s
merely a matter of giving out the right tips in the right way. If the
tip looks good the city editor and his staff does the rest.
To preserve his standing with the newspaper fraternity Jones very
frequently, if he is a real live, first-class press agent, tips off a
bit of actual news, something in which there is no $25 for him, and
which makes the city editors rise up and call him blessed. Incidentally
it also makes them all the more willing to act upon his next tip, and
this is just what Jones wants. He is merely sowing seed for the crop he
is to reap in the near future.
And do reputable physicians countenance this sort of thing? you may ask.
They certainly do; not all of them, it is true, but a big working
majority. The large cities are full of physicians of wealth and fame who
have been literally boosted into prominence by the newspapers. Fancy the
effect upon the public when it reads of Dr. Soakum being called to
attend so distinguished a citizen as the Hon. Million Moneybags, or
references to Dr. Killem, “the eminent authority on tuberculosis.” It
means a stream of dollars rolling into the pockets of the doctors thus
referred to, and puts them in position to name larger fees.
There are times when as a matter of business precaution the press agent
resorts to opposite tactics. It would not look well to be lauding Dr.
Soakum all the time. So, having previously laid out the program with the
former, the press agent hunts up another physician who knows how others
are prospering through publicity and is not averse to having some of it
for himself. The program is explained to Dr. Squills, and he writes to
the newspapers, bringing to their attention some supposedly important
medical subject. It may relate to hygiene, bad management of hospitals,
unsanitary condition of street cars, the proper means of stopping the
spread of tuberculosis, anything to attract public attention.
City editors, unless overcrowded with more important matter—and the
press agent generally selects the opportune moment—will print this kind
of “stuff” in full. Having printed it about the first thing they will do
is to send out reporters to ask the “eminent Dr. Soakum” for his opinion
on the subject. This is just what Dr. Squills was induced to break into
print for. Dr. Soakum will endorse the latter’s letter, praise it warmly
and perhaps bring out some new points which Squills has purposely
overlooked. This gives Squills a chance to come back with a statement as
to the importance of the suggestions made by Dr. Soakum, and the two old
hypocrites thus get a lot more free advertising. All of which means more
prominence, more fame, and more money.
Some years ago—about ten at this writing—a new treatment for chronic
nervous and mental ailments was introduced. Its sponsors were men of
high standing in the profession, instructors in leading medical
colleges. That the treatment had great merit is undeniable; many
wonderful results were accomplished with it. It also had great
money-making possibilities, but the promoters did not know how to
develop this feature.
Finally they engaged a press agent—we’ll call him Mr. Johnson, because
that is not his name. His terms were $50 a week salary, and a royalty on
the business. For three or four days Mr. Johnson did nothing except post
himself as to the scientific features of the treatment and he was soon
able to talk more glibly and intelligently about it than the physicians
in charge. Then one day he said:
“Trot out some of your star cases. I want to look them over.”
Mr. Johnson went over the records carefully and selected one which
seemed to give promise of producing a big free advertisement. It was
that of a well-known, well-to-do merchant in a neighboring city who a
year before had been seized with primary dementia. Homicidal tendencies
developed and his family, on the advice of prominent alienists, placed
him in a sanitarium, the physicians at which, as well as those called in
by the family, pronounced the case absolutely incurable and hopeless.
In time the new treatment was administered. In ninety days the patient
was discharged as cured, returned to his home, and resumed charge of his
business. To this day he is well mentally and physically, and no one,
unacquainted with his history, would ever think he had been insane, and
confined as a dangerous lunatic.
Having satisfied himself as to the accuracy of the story, Johnson’s next
move was to plan out a line of action. The story to be acceptable in a
news way, and carry plausibility with it must come from the patient’s
home town. It would never do for Johnson to offer it to the newspapers
himself. His connection with it must be carefully concealed. The first
thing he did in this direction was to ascertain who handled the
correspondence that was sent out to the big dailies from this particular
town. He found that it was virtually in the hands of a Mr. Wheeling,
city editor of a local paper.
Armed with this knowledge Johnson took a train and went to the town in
question—it is only a few miles from Chicago—timing himself so as to
arrive there when Mr. Wheeling had finished his rush work for the day.
Arriving there he introduced himself to Wheeling as follows:
“My name is Johnson. Pardon me for intruding upon you, but I’m a
stranger in town, with a little spare time on my hands, and being
somewhat of a newspaper man myself it seems sort of homelike to poke
around an editor’s den. It’s the best way I have of killing time and, if
it doesn’t annoy you, I’d like to pass away an hour or so chatting over
newspaper work and newspaper men.”
Wheeling, a cordial, whole-souled chap, made Johnson welcome, and they
were soon very friendly, exchanging reminiscences, and regaling one
another with their experiences. Johnson was in no hurry to spring the
trap. He was too smart for that. He produced some good cigars and, after
they had talked for an hour or so, invited Wheeling to take dinner with
him at the hotel. Wheeling accepted, and after the meal, when fresh
cigars were lighted, Johnson proceeded to set his trap as follows:
“Once a man has the newspaper fever he never gets it out of his blood,
at least not entirely. I’m better off now financially than I could
possibly expect to be working as a reporter or editor, and yet
frequently the old desire to cover an assignment, or write a good story,
takes hold of me, and takes hold hard. It’s galling for a man of my
disposition to run against a good story and not be able to make use of
it, but this is happening with me right along. Why this very afternoon,
in conversation with a business friend just before I met you, I heard a
story that’s a corker, and would make a big sensation if it ever got
into print. But pshaw, what’s the use of talking, I’m simply not in
position to make use of it, and might as well pass it up. It goes
against the grain though, I can assure you.”
“Why not give me the tip?” asked Wheeling. “I’m correspondent here for
quite a list of papers, and a real live story, one that I could spread
on, would mean considerable to me.”
“Well,” replied Johnson, “I don’t mind giving you such facts as I have,
but of course I can’t vouch for their accuracy. All I can say is that if
your investigation establishes the truth of what I have heard all the
big papers will want the story by the column, and then some.”
Johnson then proceeded to outline the story to Wheeling, hesitating
purposely as if not quite sure of the patient’s name, and giving one
that sounded much like it, but was not the real one. The trap was
sprung. Wheeling knew the man, and at once realized that he was in line
for a big Sunday spread. It would not do to waste so good a yarn on the
daily issues in which a stick or two of space would be the limit when he
could place a column or more in each of the Sunday papers. Wheeling
furnished his correspondence at space rates, so much per column, and he
naturally wanted to make the story as full and complete as possible.
That very night (it was Monday) he visited the home of the miraculously
cured man. The latter talked freely, corroborating all the important
details. Wheeling’s next visit was to the home of the family physician,
and there he got more corroboration. The next morning he wired the
various Sunday editors as follows:
Prominent business man here, after being pronounced incurably
insane by eminent specialists, and confined in asylum, fully
restored to reason by new and novel treatment. Big story. How
much?
He was swamped with replies. Every Sunday editor wanted more or less of
it. Most of them wanted it in full, the orders reading something like
this:
If sure of facts, and man is really prominent, send story in
full. No limit. Also get pictures of patient, and others
concerned.
The following Sunday morning every newspaper in Chicago fairly
“shrieked” forth the news of the new treatment. It was given to the
public in the form of a first-page story with the emphasis of leaded
type, “scare” heads, and pictures of the patient. The Associated Press
took it up and wired a report to all American papers, while a condensed
statement was cabled abroad.
Nor was this all. Managing editors from New York to San Francisco, from
Toronto to New Orleans, called upon their special correspondents to rush
more particulars by wire. The managing editors of the Chicago papers
instructed their city editors to obtain statements in full from the
physicians interested, as to the scientific nature of the treatment, its
history, etc. (The names and addresses of these physicians being given
in the first story, the locating of them was easy—it was part of Mr.
Johnson’s plan.)
What was the result? The new treatment was immediately “boosted” into
world-wide prominence. Half a million dollars would not have paid for
the publicity it obtained in one week. Indeed it would have been
impossible to buy this kind of publicity—straight news—at any price. It
made fortunes for the men interested. To-day, ten years after this
publicity, these men are still reaping its benefits.
Now these men, it should be remembered, were and are strictly ethical.
They frown upon anything that smacks of violation of the code. They will
not sell the treatment to physicians who advertise. Their dealings are
confined to those who can show a clean bill of health in this
connection. To those who meet the demands in this respect they furnish
the treatment at $27.50 per 2-ounce vial; the cost of producing it is
about 75 cents. Nice profitable business? Well, rather.
The lesson of all this is that it pays physicians to advertise, provided
they do it in the right way, and are clever enough to hoodwink their
professional brethren as well as the general public on the question of
ethics. The man who openly engages a real press agent and pays his money
for “display ads” in the newspapers is tabooed, his name is anathema.
The man who engages a press agent quietly to get up schemes by which the
gentlemen of the press may be worked for valuable publicity is
thoroughly ethical, and remains in good standing in the profession.
Wherein lies the distinction? I must confess that it is too fine for me.
Of the two the honor seems to be with the doctor who proceeds to ask for
patients in a straight-forward business-like manner, and pays the
newspapers for the space they give him. On the one hand we have the man
who pays for what he gets, while on the other we have him who, in
reality, is obtaining goods under false pretences.
Just another point about ethics. It is strictly unethical for a
physician to prescribe or administer a remedy the formula of which he
does not thoroughly understand. But thousands of them are doing it
daily. Where is the physician, for instance, who knows in reality, aside
from the proprietors, the composition of Anti-Kamnia, but does lack of
this knowledge stop its widespread use? Not at all. It’s the same way
with acetanalid and scores of other preparations. Occasionally the
proprietors of some remedies seek to ease the conscience of some extra
scrupulous practitioner by printing what appears to be a formula. But in
such cases there can be no assurance that the formula is correctly
stated, the proper quantities given, or the method of preparation
absolutely stated. In all such cases the alleged facts must be taken on
faith.
The author has in mind one particular instance, the accuracy of which he
can vouch for because he was interested in the preparation and sale of
the remedy. A certain hypodermatic treatment was placed on the medical
market “for the use of physicians only.” To satisfy the ethical
gentlemen the formula was given, and it was given correctly. Nothing,
however, was said about the method of preservation. This was an
important item as the remedy consisted of a combination of animal
tissues and fluids which would decompose quickly, and if injected into
the human system would work havoc. To keep it in condition for use, with
its curative properties intact, it was necessary to put it through a
preservative process in the course of which various chemicals and other
substances were added. Nothing was said in the formula about this
feature, nor did the strictly ethical physicians who used it make any
enquiry about it.
Common sense, to say nothing about medical training, should have told
them that a remedy prepared after the formula as stated must decompose
rapidly unless some preservative process was employed, but a little
thing like this did not seem to bother them. They just simply glanced at
the formula, wondered they had not thought of it themselves, and jabbed
it into their patients according to directions.
What assurance did they have that, if the remedy was not properly
preserved it would not injure, and perhaps kill the people upon whom it
was used? What assurance did they have that, if the remedy had been put
through a preservative process, it did not contain some substance which
would be equally injurious? None whatever. Their actions were equivalent
to saying they didn’t care.
This, to the careful, conscientious physician, would seem like coming
close to the danger mark, and so it was. To speak plainly it was little
short of criminal carelessness, and yet these practitioners were all
thoroughly ethical. The only possible excuse for them is to say they
thought they knew, but this is actually no excuse at all as, under their
obligation it was their duty to know beyond doubt what they were using.
As Dr. Lydston asks in the opening chapter, “Why not be honest” about
this publicity matter, and, he might well have added, all the other
features of modern medical practice as well. There is no excuse for
honest practitioners leaving the use of the public press to quacks and
fakirs—and the few really good physicians who are smart enough to take
advantage of it while at the same time “pulling the wool over the eyes”
of their professional brethren.
Such tactics as now prevail, cloaked under the guise of ethics, are
unfair to the young medic. They keep him from doing the very thing which
the self-appointed Lord High Apostles of Ethics are doing, and waxing
rich and famous thereby.
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