Today we have the third and final part of a guest post written by David Herzberg, Ph.D., who will present “The Other Drug War: Prescription Drug Abuse and Race in 20th-Century America” on Tuesday, October 22. Read part one here and part two here.

We don’t have a definitive history of medical advertising (dissertators, take note!). In fact, the world of medicine barely appears in the standard histories of advertising beyond 19^th-century patent medicines. We know all about the key campaigns that transformed the wider advertising industry: Uneeda Biscuit and Oleo margarine in the Progressive Era, Wonder Bread and Dwight Eisenhower in the 1950s, the Volkswagon Beetle in the 1960s, and so forth. The annals of medical advertising begin promisingly with a chapter on patent medicines but then basically peter out.

“The obvious anxieties that preoccupy many middle-aged minds often obscure a coexisting depression.” From JAMA, volume 209, number 1 (September 22, 1969). Click to enlarge.

Obviously any such history would need to be based, in part, on the records of a medical advertising company or the in-house marketing arm of a pharmaceutical company. But they also require access to the advertisements themselves, in the context in which they appeared—i.e., among other places, in medical journals.

It’s not just historians of medical marketing who need the advertisements. Anyone interested in the history of medicine, or of medicine’s relationship to society at large, should care about them. The ads and the articles talked to each other, either through their joint acceptance of larger cultural beliefs or through vigorous debate when professional and profit-seeking agendas clashed. Advertisements also provide a bridge to connect such medical histories to broader developments, via the same links that contemporaries deplored. “They sell medicine like soap!” raged witnesses before Congress in the 1950s, believing that this was argument enough to win the day. This same observation, less polemically framed, might tell us as much about soap and the consumer culture as it does about medicine.

“In many cases the result of ’empty-nest syndrome.'” From JAMA, volume 232, number 2 (April 14, 1975). Click to enlarge.

This is why it was a historic mistake to cut out the ads. And it’s a mistake that we may still be making: today’s online databases offer a la carte articles without the surrounding advertisements, nearby articles, particular layouts, cartoons, etc. (Medical journals used to have cartoon pages; editorial policy apparently insisted that these mostly be nasty pokes at women patients. These pages, too, were often sliced out by well-meaning librarians.)

As I noted before, the New York Academy of Medicine was the only library I have found that did not cut out the advertisements. And even there policy changed for a while in the 1970s. I still don’t know why they had the prescience to spare the advertisements, but we are lucky that they did. It makes for a precious collection that is unlikely to be made obsolete in the digital era.

Today we have part two of a guest post written by David Herzberg, Ph.D., who will present “The Other Drug War: Prescription Drug Abuse and Race in 20th-Century America” on Tuesday, October 22. Read part one here and part three here.

This story of medical journal advertising is typically cast as what historians call a “declension narrative,” a tale whose main arc tracks a decline from the honorable virtues of past generations to the immoral venality of today. In this telling, commerce and marketing slowly colonized the therapeutic endeavor, transforming from the noble pursuit of health into an untrustworthy, buyer-beware precinct of the larger consumer culture.

But this story can also be told very differently.

After all, there had always been advertisements in the medical journals, and subscribers had always been able to see them—they had no librarians to slice-and-dice for them. Subscribers read the articles in the context of having also seen the ads.

“For the ‘Cheater Eater.'” From JAMA, volume 207, number 11 (March 17, 1969). Click to enlarge.

What might they have drawn from the experience of flipping through the unexpurgated journals? Well, historians have had a field day analyzing the messages of particular ads or particular articles. But the overall structure of the journals also sent its own message. When subscribers flipped past the bundle of advertisements before the table of contents to the ad-free material within, they saw to their satisfaction that commerce had been carefully contained where its self-interested values would not contaminate the real work of medicine—the empirical pursuit of truth, the professional sharing of new ways to alleviate illness and suffering, etc.

And yet, as historians have repeatedly demonstrated, commerce, especially the pharmaceutical kind, had long been a powerful force in medicine. From Parke-Davis’ hyping of cocaine in the 1880s, to Smith Kline French’s careful orchestration of research on amphetamine in the 1930s and 1940s, to Carter Product’s “launching” of minor tranquilizer Miltown with a public relations campaign worthy of a Hollywood starlet, drug companies and their marketing departments are ubiquitous in the history of medicine if you look for them. Their influence was only heightened, ironically, by their loud protestations that their marketing campaigns had no influence on physicians’ therapeutic decisions—doctors, they said, were obviously far too smart and well educated to be swayed by Madison Avenue gimmickry. Few physicians were inclined to argue with such logic, and so the marketing hoopla remained paradoxically below the radar, relatively free of scrutiny or regulatory oversight.

“A sleeping pill for night squawks.” From JAMA, volume 207, number 10 (March 10, 1969). Click to enlarge.

From this perspective, we might all have breathed a sigh of relief when the 1950s rolled around and medical journals finally came clean, giving advertisements the pride of place they had long ago earned and beginning the process by which Americans would come to recognize, and grapple with, the centrality of commerce in their medical system. It is no accident that formal regulatory control of medical advertisements was finally given to the FDA less than a decade later.

Today we have part one of a guest post written by David Herzberg, Ph.D., who will present “The Other Drug War: Prescription Drug Abuse and Race in 20th-Century America” on Tuesday, October 22. Read part two here and and part three here.

It’s a historian’s nightmare: librarians spent the better part of a century diligently cutting out and throwing away some of the most important parts of the journals they received each week before binding and shelving them. Precious historic material—capstone work by some of the nation’s brightest and most creative minds—was destroyed by the very people devoted to preserving it, and destroyed only more thoroughly because of those peoples’ good intentions and zealous work ethic. Why would they have done such a terrible thing?

This is no hilariously nerdy horror movie. It really did happen all across America for most of the 20^th century. As far as I can tell, the New York Academy of Medicine stood almost alone in deciding—who knows why—not to rip out the advertisements in their medical journals. We owe them sincere thanks for this.

“‘Deprol helps brighten the depressed patient’s world.” From JAMA, volume 204, number 4 (April 22, 1968). Click to enlarge.

It’s pretty clear why most librarians cut out the ads, and it wasn’t just to preserve space on their shelves. Back in the day, the medical profession prided itself on being insulated from crass commercialism, and major journals like the Journal of the American Medical Association not only insisted on approving each advertisement, it also lumped together all the ads in an easily removable bunch before and after the main body of the journal. Ads were thus clearly identifiable as separate and unrelated to the pristine knowledge housed in the journal’s interior. Why would a good medical librarian save them?

We all know what happened next. Sometime during the consumer culture revolution of the 1950s, when commerce stopped being crass and instead became a beacon of liberty in the fight against communism and a practical organizing principle of most American institutions, consultants advised the American Medical Association to embrace journal advertising. Ads began to proliferate, and they became bigger, more colorful, and ever more dependent on emotionally charged images to convey the kinds of before-and-after miracles of Madison Avenue. Then, one day, they broke out of their quarantine and began to appear in between articles throughout the journal. Advertising became so ubiquitous, and so important, that a separate “Index of Advertisers” was provided in the back of JAMA to help readers locate the ads just like the table of context helped them locate the articles. In a sense, the ads became a shadow journal alongside the articles, providing more digestible (and typically more optimistic) reports from the cutting edge of medicine.

Triavil: Tranquilizer-antidepressant for the anxiety/depression complex.” From JAMA volume 194, number 8 (November 22, 1965). Click to enlarge.

It was only a matter of time until ads became so thoroughly enmeshed that it was no longer possible to cut them out without also removing parts of articles. Librarians continued to try, however: as late as the 1970s and 1980s, they diligently sized up each page and sliced out whatever advertising they could. Those decades are especially frustrating for historians, if you ask me. We can see the appetite-whetting first and last page of, say, an eight-page mega-advertisement on Valium and “the modern man,” but the meat of the sandwich was long ago pilfered.