CHAPTER III

=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.