Chapter 3: The Consolidation of Authority 1850-1930

As Starr recounts the history of medicine in America, I am continually stuck with the relative role of timing. Rather than a focused movement, the consolidation of authority for physicians seems almost accidental. A few legislative priorities, a scathing report of medical schools and the influence of societal factors such as transportation and urbanization better explain the consolidation of authority than any efforts from within the profession. The comment that sticks in my mind is that which stated that the biggest enemy of physicians were the physicians themselves.

Hindsight is always 20/20 and I imagine the physicians who worked in both the late 19th century and early 20th century would agree that had they known the benefits of consolidation and cooperation, they would have advocated for them earlier. Instead it took the donation of a huge endowment from Johns Hopkins, the leadership of Harvard's president and eventual acceptance of sectarian physicians into the mainstream to march forward towards true professionalism.

It is interesting to me to observe the backswing of the pendulum towards homeopathy. Although generally considered alternative, it seems that alternative medicines enjoy regular spurts of popularity in response to concerns in the medical community. For example, when a report was released that stated that hormone replacement therapy (HRT) was dangerous to menopausal women seeking relief, we saw a rise in alternative solutions such as black cohosh. While I personally dispute the findings on HRT, it is interesting that as consumers, we often view homeopathy as a safer alternative to "drugs." Another example is "Airborne," the miracle tablet marketed by a teacher that alleged great effectiveness against colds with natural ingredients. In clinical studies, Airborne has not outperformed placebos, but for many consumers, the idea of fighting colds naturally is still highly attractive. In recent months, I have observed another backswing as the economy has fallen. Unwilling or unable to bear the cost of doctor's visits, people seem to again be turning to natural remedies for an economical solution. Although I do not discount the benefits of natural remedies, I am always concerned when people assume that because it is directly from the earth (as opposed to derived from, like many "drugs"), there are no side effects, no risks.

Finally, it is interesting to hear about the AMA in its nascency. In a recent economics class, a professor remarked that the AMA is a cartel. I disagreed, stating that although it may be a cartel by definition (controlling the market via medical schools), it is not a cartel in intent or even effect. The plethora of reimbursement structures themselves mean that increasingly, physicians individually and the AMA collectively, lose control over the market. While I don't anticipate a return to the AMA in its diffuse, powerless state, I wonder if the AMA percieves shifts in the health care market to be chipping away at its authority.