$2.3 Billion dollars; in 2009 Pfizer paid this largest-ever pharmaceutical bribery. In 2012, Glaxo-SmithKline surpassed it at $3 Billion,1  and that’s only when they get caught breaking the law. Most of the money they spend to compel your doctor to do their bidding is perfectly legal.

It would be full time work for an investigative journalist to uncover how much money pharmaceutical companies spend buying influence in the medical and political realm; their websites and filings are drenched with assurances of transparency, but hours of combing through them reveals only opacity.

In Part One of this series on the founding of the American Medical Association (AMA) and the hijacking of American health care, we discussed the rot at the root of the anti-competitive AMA, an organization established to ensure that consumers would be deprived of choices so that inferior practitioners could protect their incomes. 

In this Part Two, again drawing from the masterful work of Harris Coulter, I will discuss the second phase of this operation, which was the influencing of the AMA by the pharmaceutical companies (pharmas), also in the 19th century. Again, homeopathy plays an important role, one which may help the reader understand why it became essential to the health of the pharma-medico-industrial complex to ostracise and vilify this mode of medical thinking in order to protect AMA/pharma incomes, and very survival. 

“Patent Medicine,” drugs with undisclosed ingredients, sold under proprietary labels, dates back to the dawn of entrepreneurial adventuring, but the widespread adoption by the public of these concoctions gained traction in the mid-19th century.2  

At this time, both the homeopathic and the allopathic physicians treated patients with natural and generic substances, albeit of different origins and preparations. Whether toxic crude mercury or gentle dynamized pulsatilla, the pharmacists dispensed from common stocks with full disclosure of the contents. Even as the war between homeopathy and allopathy raged and ebbed, there was general agreement across the camps that the “patent nostrums”3  were a scourge, and unethical to endorse. 

The homeopaths, who practiced individualized care based on evaluating the totality of symptoms in each patient, had no use or affinity for such products. They disdained the allopathic system of prescribing preconceived protocols based on theoretical diagnostic categories which ignored inconvenient individualizing symptoms. 

The allopaths (Solidists, as they early termed themselves, versus the Empiricists) focused on mechanistic explanations and naming diseases, and then classifying drugs accordingly. Self-prescribing of patent drugs threatened that domain, because the patients themselves could diagnose their own disorders and purchase drugs marketed to match (Ask your doctor about Snake Oil!). 

However, because this same approach simplified professional practice and allowed the physician to attend many more patients (and thus draw a larger income), proprietary preparations began to gain traction among professionals. Ostensibly, these were different from “patent” medicines due to their disclosures, but the manufacturers found ways to protect their claims with obfuscation, then as now.4 

While Part One demonstrates that truly curing you, the consumer, in your sickness and suffering, has always been secondary for the AMA to its perpetuation and profits, the following paragraphs will reveal that the exploitation of those motives by the pharmaceutical industry for its perpetuation and profits goes back almost as far. 

“The rising generation of physicians knew little or nothing about pharmacy other than what knowledge they were fed by the manufacturers,” opines Coulter; much like today, the doctors were taught to diagnose disease, and then to take the pharma’s word for it that their formulation provided the solution. 

Medical associations have always been financed by the dues of their members, the sales of their publications, and sponsorships, partnerships, and grants. As the allopaths strove to increase their political influence in order to legally box out their competition, they needed money; money to lobby, money to pressure medical schools, and money to promote themselves. 

The pharmas realized they could put doctors on the payroll of their own promotional journals, and spend heavily on both advertisements and advertorials in association periodicals.5  While this is now the practice of publishing articles penned by researchers with rampant conflicts of interest, (see former Lancet editor Richard Horton’s well known comments that ‘Journals have devolved into information laundering operations for the pharmaceutical industry,’6) early on the AMA clung to its ethical standards while seeking to grow its budget. 

They did, for a time, ban such advertising and promotion in their journals, and were compelled to censure some publications in the 1880s, but the ban put sufficient strain on their finances that they ultimately embraced the advertisement of proprietary pharmaceuticals as their primary source of income.7 

The homeopaths refused such advertisements, and the consequences were dramatic. Whereas by 1909, the AMA was raking in $150,000 from pharmaceutical promotion, the AIH pulled in at most a few thousand; these stark differences in resources meant that the homeopaths were unable to effectively parry the onslaught brought by their opponents through the pressure on politicians and medical schools8.  

In 1910, when the Carnegie Endowment financed Abraham Flexner’s famous report evaluating medical schools, the AMA had so effectively marginalized any schools teaching anything other than AMA orthodoxy, that it was a simple thing to demonstrate that alternative medical colleges could not meet the AMA criteria, which the medical licensing boards had adopted as a condition of practice. 

None of this could have been achieved without the groundwork laid by the AMA in the middle of the 19th century to marginalize their competition, nor without the financing from pharmas. Once allowed in the tent, the pharmas relentlessly expanded their influence, and the former predators became, themselves, the prey.

It is naive to believe that anything other than open and transparent competition can put a check on the deception and defrauding of customers through opaque political and corporatist manipulations. The incentives will always be there, and, the more threatened an industry feels on the basis of its merits, the more vicious will its defenses become. American medicine did not get hijacked during Covid, or by government subsidies of insurers and employer medical benefits, or by Medicaid; these abuses flooded into established grooves. The industry has never been acting in your interests. 

The more educated, open-minded, and independent of that system you become, the better your health will be. The alternatives are much closer than you may think, and it is incumbent on us all to become more savvy consumers. 

1https://projects.propublica.org/graphics/bigpharma

2.Coulter, Harris. 1973. Divided Legacy, The Conflict Between Homoeopathy and the American Medical Association. North Atlantic Books., p.101

3.ibid, p.101

4.ibid, p.404.

5.ibid, p. 415

6  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61019-2/fulltext

7. Coulter, 1973, p. 419. 

8. ibid, p. 442.