EDITORIAL


EDITORIAL. Who stands to lose the most by this revision of the medical ethics dose? Obviously the patient, the very person whose welfare should be the first consideration of every physician. A patient goes to a doctor because he is ill and needs the doctors professional services.


DO YOU DISPENSE DRUGS?

Do you dispense drugs? If you do, you are not an ethical doctor according to the AMA Principles of Medical Ethics, as amended June 1954. Section 8 says: It is unethical for a physician to participate in the ownership of a drug store in his medical practice area unless adequate drugstore facilities are otherwise unavailable. This inadequacy must be confirmed by his component medical society. THIS SAME PRINCIPLE APPLIES TO PHYSICIANS WHO DISPENSE DRUGS OR APPLIANCES. In both instances the practice is unethical if secrecy or correction are employed, or financial interest is placed above medical care. On the other hand it may sometimes be advisable or even necessary for the physician to provide certain appliances or remedies without profit which patients cannot procure from other sources.

Who stands to lose the most by this revision of the medical ethics dose? Obviously the patient, the very person whose welfare should be the first consideration of every physician. A patient goes to a doctor because he is ill and needs the doctors professional services.

Considering the patients health and the patients time, why shouldnt he receive his prescription at the same office visit or home call? Why should he make two trips when one will do? At night store is often several miles from the doctors office, why impose an unnecessary inconvenience upon a sick person? In addition to saving the patients time and energy, the patient is generally saves money, as he gets both his medicine and office call for the same price.

From the doctors point of view, dispensing drugs does take extra time, and is a brother for the additional space required in the office. This trouble is greatly offset by the satisfaction of knowing exactly what each patient is given. There will not be unknown substitutes in quality of drugs or in the directions for their use. To homoeopathic doctors this is important.

Each homoeopathic doctor carefully protects and keep his remedies so they will maintain constant potency year after year. Samuel Hahnemann in his careful precise way was unhappy with the careless manner in which druggists compounded his prescriptions. He talked and wrote much about it. This resulted in the embittered druggists securing a strict law against physicians dispensing drugs in that area. Hahnemann moved to another part of Germany.

The National Pharmacy Association has asked the AMA to take active steps to bar all individual and group practicing doctors from dispensing their own drugs and to strictly enforce this new section 8 of the ethical code. If the AMA does not work fast enough, it is quite possible that the National Retail Drug Association, working through state association, will try to pass laws making it illegal for physicians to dispense drugs.

Work is already underway in Wisconsin by the Retail druggists Association to build a favorable public opinion to pass this law. The State and local medical societies are literally hamstrung to fight the passage of this law because of this revision in medical ethics by the AMA which forbids doctors to dispense except in unusual circumstances. So how can the doctor fight the same thing he says he is nationally against by his ethical code. A fine state of affairs!

The druggists of course have an argument too. They say the doctors are consistently violating the AMA and ethical code because they dispense of profit. I feel that the number of doctors who sell their drugs for a profit is very small, certainly less than 10 percent of that 33 percent who do some dispensing. There will always be some doctors who are out for a “quick dollar” in any area of medicine, whether they are “eye doctors” “allergy shot” doctors, dentists, chiropractors, osteopaths, or cultist practitioners.

These few profit-chaser will always cast a long shadow of doubt on the 90-95 percent of the physicians who dispense their own remedies at cost to the patient.

Secondly, the druggists insist that medical doctors are in serious competition with them. This argument seems out of keeping with survey made by Medical Economics in 1948 and 1952. In 1948 the report showed 45 percent of the doctors dispensed SOME drugs, and only 2 percent (thats us) who dispensed ALL their drugs, and only 2 percent (thats us) who dispensed ALL their drugs. Four years later, in 1952, a similar survey showed that only 35 percent dispensed SOME of their drugs. How a declining minority of doctors poses such a competitive problem to the druggists is hard to understand. The claim is mainly made against the group practicing doctors who have their own pharmacies. The druggists say this isnt ethical even though the group of doctors have a licensed pharmacist in charge of all drugs and dispensing.

It would seem a ridiculous paradox for the druggist to holler about doctor-competition when the same druggist sells, in active competition with other stores, electrical appliances, sun glasses, proprietary drugs of questionable value, jewelry, toys, sporting goods, clothing dishes, etc. In fact it is hard to find the drug counter in some of these “drug” stores. This phase of competition does not seem to bother his either for his fellow merchants, but a steadily declining minority of dispensing doctors gives him great concern.

Has the National Retail Druggists Association considered the volume dispensing of so called “foods” like vitamins, ground alfalfa tea, desiccated seaweed, dispensed by chiropractors, osteopaths, and door to door salespeople selling products such as Nutrolite? Have the druggists also considered that TOO MANY drugs stores in many city areas is far worse competition than a few dispensing doctors.

Evidently the revised ethical code was not well received by many doctors throughout the United States. At the National AMA Convention in June 1955, the Reference Committee on Miscellaneous Business dealt with 10 resolutions concerning the dispensing of drugs and appliances by physicians. The Chairman of this committee reported to the House of Delegates that the Committee felt that the Code of Ethics should be stated in broad principles rather than attempt to interpret principles in detail. He recommended that the following statement be substituted in place of section 8. To wit:

It is not unethical for a physician to prescribe or supply drugs, remedies, or appliances as long as there is no exploitation of the patient.

Immediately a motion was made to postpone the adoption of this recommendation by the House of Delegates until the Clinical Meeting in Boston November 29-December 2, 1955. It was urged that a copy of this committees report be sent to all delegates for study before the Clinical Meeting in Boston.

The right of every doctor to use those drugs or remedies he deem best suited to that patient should not be annulled by any code of ethics which indirectly assures special profits to specific groups. The dispensing of remedies is vital to all doctors and especially to homoeopathic doctors. There must be considerable doctor-interest in this problem as evidenced by the 10 considerable doctor-interest in this problem as evidenced by the 10 resolutions that the AMA committee had to consider in reaching its latest recommendation.

It would appear that many doctors think and feel the same as homoeopathic doctors. While there are a few months left before the Boston Clinical Meeting, wouldnt it be worthwhile to contact the local AMA society and find out how your state representative to the House of Delegates thinks about this problem of ethics? Register with him the need for his voting that the new section 8 be adopted as read. If those delegates who represent the home doctors know now we feel, it will give them courage the home doctors know how we feel, it will give them courage not to be swayed doctors know how we feel, it will give them courage not to be swayed by the glib talk of the druggists.

One cloak room argument used behind the scenes is a package bit of politicking that the druggists will use their influence to fight socialized medicine if the doctors will cooperate on drug dispensing.

I realize that the IHA has little in common with the AMA, but it is also true that is a mutual problem. There are members in the IHA who are also members of the AMA. It will do us no good to stick our heads in the sand and claim we are immune to the present problem. Where do we have a better chance to win than when the majority of U.S. doctors are interested and willing to correct this ethical blunder of a year ago?

If the IHA is unwilling or recognize this right to dispense remedies as its own problem, then it must be willing and ready to protect each of its dispensing doctors from “smear tactics” and “undesirable publicity” when the druggists have organized public opinion their way of thinking.,

Now is the time for each of us to do something about this. Pick up your telephone or postcard and find out about your own House Delegate.

Rabe R F