Side Effects May Include Intellectual Snobbery
Joe Spillane recently pointed us to Caroline Rance’s blog, “The Quack Doctor,” and suggested that her posts – filled with advertisements for things such as “Carter’s Little Liver Pills” and “Effervescent Brain Salt” – form a “reasonable platform” for historians to “ask the larger questions about consumer behavior, medical authority, business interests, and the role of each in shaping everything from health cultures to health care policy.” In that spirit, I’d like to suggest that those of us who write about the history of pharmaceuticals might want to reconsider our dismissive attitude toward the patent medicine industry. Rather than derisively laughing at the industry – look at that advertisement for brain salt! I can’t believe people bought that stuff! – perhaps it is time that we try to understand it on its own terms.
Patent medicines are a familiar topic to historians of medicine. Widely popular in the nineteenth- and early twentieth-centuries, patent medicines were typically made from secret ingredients, advertised in the popular press, and were sometimes incredibly profitable. Manufacturers frequently made what were, from today’s perspective, outlandish claims about their supposed therapeutic powers. As a result, historians have not treated them kindly: James Harvey Young, in his classic book The Toadstool Millionaires (Princeton, 1961), described manufacturers of patent medicines as dangerous quacks who preyed on a gullible public, unscrupulous hucksters who sold nostrums with outlandish names to unwitting consumers. Young’s work is still cited as the standard work on the topic, and this framework is common enough among historians that it is rarely questioned. “[I]n 1901, the most sinister pharmaceuticals were the patent remedies,” writes Nicolas Rasmussen in his excellent book On Speed: The Many Lives of Amphetamine (NYU, 2008) “All these useless and dangerous medicines were available by mail order and over the counter at pharmacies everywhere….” The horror!
Another 19th Century Quackery
The problem here is that this framework uncritically adopts the position of orthodox medicine and assumes the category of quackery rather than historicizing it. As orthodox physicians struggled for social and professional legitimacy in the nineteenth century, they leveled the charge of quackery against numerous opponents – homeopaths, eclectic physicians, Thomsonians, and numerous other medical sects and practices. Patent medicines were one of their primary targets: orthodox physicians denounced patent medicines as unscientific, dangerous, and predatorial in nature. From Young’s perspective, and from the perspective of most historians who follow the framework he popularized, orthodox physicians were essentially correct: patent medicines were, in other words, actually a form of quackery that needed to be suppressed in order to protect the health of the public. In other words, Young adopted the perspective of nineteenth-century orthodox medicine in his dismissal of patent medicines as a dangerous form of fraud, and those of us who follow in his footsteps and adopt this framework do so as well.
Yet I would suggest that this perspective misunderstands the orthodox framework in an important way. The orthodox critique of patent medicines was never only about therapeutic effectiveness: instead, it was primarily based on the longstanding assumption that monopolizing scientific knowledge for private gain was, by definition, unscientific and harmed the public. From the perspective of nineteenth-century medical orthodoxy, any effort to control medical knowledge for private gain was deeply unethical because it interfered with the ability of other physicians to help their patients. Secret ingredients were quackish not so much because the ingredients the manufacturers used were dangerous, but because secrecy itself was quackish. The same was true of patenting: although so-called patent medicines were actually patented only occasionally, orthodox physicians frequently railed against medical patenting as an unethical form of monopoly. Patenting a remedy was considered quackish because it meant that other physicians could not assemble the compound themselves, even if it was made from common ingredients and the formula was well known. Scientific knowledge was thus restricted for private gain; the ability of physicians to help their patients was curtailed, the public harmed.
Creosote and Turpentine Compound for Coughs, Courtesy of Mr. Beaverhousen's Flickrstream (http://www.flickr.com/photos/18668478@N00/)
The interesting point here is that this was not about therapeutic effectiveness as we understand it today. Patent medicines could be, and sometimes were, quite effective and still be denounced as quackery by orthodox physicians. In the early 1830s, for example, a physician from Missouri named John Sappington began manufacturing and selling pills for the treatment of fever. In many ways, “Doctor John Sappington’s Anti-Fever & Ague Pills” were a classic patent medicine: Sappington kept the ingredients of his pills secret, he advertised them in the popular press, and he made a tremendous amount of money from them. They were also quite effective. One of the ingredients in the pills was quinine, and malaria was widespread in Missouri. Sappington was one of the first – and perhaps the first – person in the United States to use quinine to treat fever, and the popularity of his pills undoubtedly had much to do with the fact that they helped people with malaria feel better. Sappington’s product was, quite possibly, one of the most important therapeutic advances of the early nineteenth century. Yet he was denounced as a quack by the local medical society – and, indeed, from their perspective he was a quack. Although he later revealed his formula, Sappington initially operated outside the norms of the orthodox medical community by monopolizing his knowledge of how to treat disease for his own financial benefit. This was the height of medical quackery, and from the perspective of his more reputable peers it made Sappington little better than notorious quacks such as Samuel Thomson.
Parthenium integrifolium ™
My point here is a pretty simple one. There were certainly plenty of drug manufacturers in the nineteenth and early twentieth centuries who cynically played on people’s ignorance and sold them shoddy products. It would be silly to try to argue otherwise. But my guess is that for every manufacturer who intentionally deceived the public there was at least another who made products in good faith and sincerely believed that his or her goods would help. Many of these products probably didn’t work, and some of them undoubtedly harmed those who consumed them, but many of them certainly did – patent medicines often contained powerful herbal ingredients, and we would be foolish to assume that they had no positive effect on the people who used them. Young’s work – and the generally dismissive framework that historians adopt toward patent medicines – is significantly less persuasive when viewed from this angle. Calling these manufacturers “quacks” is historically accurate, in the sense that their critics in the orthodox medical community referred to them in this way and, at times, they themselves adopted the term as a means to distinguish themselves from their orthodox competitors. Yet to go further than this and suggest that they were, as a whole, unscrupulous, predatorial, and dangerous to the public is to uncritically adopt the orthodox category of quackery not as a descriptive label but as an ethical and epistemological judgment and apply it whole cloth. In other words, it is to assume the category rather than explain it.
This matters because it shapes how we talk about the past. Do we describe patent medicine manufacturers as dangerous – if entertaining – hucksters who uniformly deserved to be suppressed, or do we describe them in more complicated, and perhaps sympathetic, terms? Do we describe consumers of these products as unwitting dupes, as rational actors making reasonable choices for themselves, or as somewhere in between? My point here is not to suggest that James Harvey Young was completely incorrect in his interpretation of what he called “the toadstool millionaires” – rather it is simply to call attention to the fact that both quackery and orthodox medicine are historically contingent categories that need to be explained rather than assumed. It seems to me that those of us who write about the history of the pharmaceutical industry need to spend less time dismissing the patent medicine industry and more time explaining it. Deriding patent medicine manufacturers – and the supposedly gullible public that purchased their products – is perhaps entertaining, but I am beginning to think it obscures as much as it illuminates the complexities of the past.
Patent Medicine, Meet Big Pharma