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November 23, 1994

Physician Advertising

Author Affiliations

From the Department of Emergency Medicine, Brigham and Women's Hospital, and Department of Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 01225.

JAMA. 1994;272(20):1623. doi:10.1001/jama.1994.03520200079041

One hundred years ago many generalist physicians, the backbone of the American Medical Association (AMA), felt threatened on two fronts. Although few in number, specialists were beginning to threaten generalist physicians by their knowledge claims, which some specialists unconventionally promoted in advertisements. On the other hand, generalists practiced in direct competition with a host of partly trained or alternatively trained healers, many of whom actively marketed their services. Furthermore, the rest of the US "health care industry," such as it was, operated in a climate of laissez-faire capitalism. Standards of medical education were almost nonexistent, most medical schools were proprietary, and medical licensing by the states provided few effective barriers to prevent the unlearned from entering practice.1 Consequently, many physicians found it impossible to obtain a livelihood entirely through practice. According to one medical commentator in 1892, 60% of all physicians west of the Mississippi survived financially only through

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