An ethical drug manufacturer expressed the same though a little differently: "Only products of professional interest should appear in JAMA. Otherwise the value of it as an advertising medium is considerably lessened, particularly since most readers don't discriminate between ads subject to control and those that aren't."

Two drug manufacturers took a more positive approach in their views: "The book is much too important to have valuable space being taken up by ads of no professional value."

"Only ethical products, or those of specific professional use, should be allowed in the book. There is no cookbook purpose behind JAMA. It is one of the best medical journals in the world and it shouldn't be all cluttered up with extraneous nonentities. There are too many ethical manufacturers who coud use the space to bring products of important professional use to the physician's eye." Some of the advertisers took a more liberal view. For example, this medical advertising agency man:

"I don't blame JAMA personally for accepting non-professional ads as long as they don't insult the intelligence. It's good business. But it is strongly resented by my clients. In fact, they feel so strongly about the matter that although they are all increasing their ad budgets for 1953, they will all have fewer pages in JAMA than in 1952."

Cigarette advertising was heartily damned by nearly every advertiser with whom we talked. Even the non-professional advertisers in JAMA felt that way. The representative of one of the large manufacturers' trade associations stated it bluntly:

"Cigarette advertising in JAMA should definitely be eased out. 'More doctors smoke Camels than anything else' is just a bunch of crap. It adds nothing to the believability of other ads in the book, to put it mildly. I have no objection to the Buick ads. But the cigarette stuff is obnoxious to almost anyone, including members of the profession."

An ethical drug manufacturer stated:

"Food ads belong in the Journal. Cigarettes, especially Philip Morris ads, are completely out of place. Their exhibits—the rabbit's eye with a pseudo-scientific approach—is greatly resented by the manufacturer who has had the headaches of getting Council Acceptance."

A small drug manufacturer extended his restriction of non-medical advertising to the conventions:

"Non-professional products should be completely excluded from JAMA. This is extended to conventions, which have become like twice-a-year circuses. If the AMA expects its advertisers to be ethical, and enforces standards against them, it should at least do likewise to the non-medical advertisers. The non-ethical inclusions, and especially those of pseudo-scientific validity, have been making everyone sore. They should be tossed right out. The cigarette ads especially." A large consumer advertiser who has very little advertising in JAMA stated: "About JAMA advertising-when an advertiser advertises in JAMA, he should advertise to the reader as a human being, or he should talk to him in professional language. Mixing consumer talk with professional talk doesn't get very far. Such a practice degrades the publication. The car advertising is okay. But JAMA should definitely cut out cigarette advertising as it now appears. I object in general to any medical claims where there is no matter of medicine at all involved."

A publisher of medical books give this suggestion:

"Limit the proportionate amount of space allowed to nonprofessional ads in the book. Throw out all the phonies. This means especially cigarettes."

Most of the people who condemned non-professional advertising in JAMA condemned it also at the conventions. Here are two typical statements, the first by a large ethical drug manufacturer, the second by a manufacturer of X-ray equipment:

"The conventions have become a circus because of the type of people they let exhibit there. It takes an active imagination to associate them with the medical profession. They even display pots and pans. Make it more of a medical meeting and less of a circus-this is what they should do."

"The AMA has done itself discredit by securing a lot of diverse products which have no relationship to the medical field. This is very evident not only in JAMA but also at the conventions. The conventions are becoming a circus."

A medical advertising agency man stated:

"Conventions are a laughing-stock. Burlesque shows complete with life-anddeath products and developments of legitimate advertisers."

Another ad agency man commented:

"Clean up conventions and take out of them the burlesque show routines." This statement, offered by a large ethical drug manufacturer, introduces the idea of Council Acceptance at the conventions:

"Conventions first of all must be improved. They are like county fairs, and things are not only disorganized but ridiculous. Not only cannot samples of nonCouncil Accepted products be given out, but instead of trying to make a convention a dignified affair and keeping out the side-show experiences, the AMA spends its time sending spies around to find out if a manufacturer is giving away free headache powders. Even if a physician personally requests a product which is not advertised, we can't give it to him."

Three ethical drug manufacturers made these comments:

"Conventions are terrible. Our own queries show that physicians regard conventions as holidays, and as the least effective phase of the AMA operations." "Conventions are terrible for advertisers. Besides too much midway activity,

they are always out of the way. The point system, too, is very bad."

"The midyear clinical session is a poor thing. It could be good, but it is always in an out-of-the-way place. If you don't go, however, you get a bad spot in the main convention."

One ad agency man complained of discrimination at conventions:

"The AMA conventions are too much like county fairs. The point system is unfair and discriminatory. The ethical advertisers and exhibiters are unable to compete with the girly shows. The AMA is not consistent-it lets big advertisers do what small ones can't."

The last comment on conventions which we are quoting, made by a manufacturer of X-ray equipment, was concerned chiefly with samples:

"The objective at AMA conventions seems to be to collect free samples. In fact, some of the commercial firms even furnish shopping bags with their name on the side as another means of advertising.

"The conventions give the appearance of being tremendous affairs, crowded with people. As far as the exhibitors are concerned, however, the attendance is often not good, even in spite of the big crowds. At least half of the people who attend the conventions could not buy the products exhibited anyway.

"It might help if the AMA could tighten up a little better as to who is allowed to attend the convention. They are not so big that they cannot be handled except in certain cities. The clinical meetings are always handled in other parts of the country, and this adds greatly to our expense. We dropped the clinical meetings this year."

The question of inserts was mentioned spontaneously by the majority of the advertisers interviewed. About half of the advertisers expressed a definite dislike for the Pfizer Spectrum insert because they felt that it gave Pfizer an unfair advantage over the other advertisers and because they felt it made the AMA the publisher of the Pfizer house organ.

About a quarter of the advertisers expressed admiration and complete approval of the Pfizer insert, and regretted that they had not initiated the idea instead of Pfizer.

Roughly another quarter approved completely of the ad from Pfizer's point of view but felt that from the AMA's point of view, it was a mistake in policy to accept it, chiefly because if others followed the precedent, JAMA would end up as being a hodgepodge of house organs and editorial matter, with the reader confused as to which was which.

One medical ad agency man made the following favorable comment: "Spectrum is a big help to the book. It dresses it up and makes it more interesting. The MD's will turn to it the way they do to OP and PSM. It helps the book in appearance and helps the advertisers because it brings on more interest and readership of the ads. The rest of the book ought to be as good." Four different ethical drug manufacturers made these comments:

"I suppose the Pfizer insert is being criticized by a lot of people, but personally I consider it helpful rather than the opposite. I wish all advertisers would make their ads as interesting to the doctor as these Pfizer ads. I should like to see a campaign to encourage advertisers to produce educational copy of this kind."

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"I think the Pfizer ad is an excellent idea as long as it remains as good as it is, and I think it will. Other advertisers can't complain. As a matter of fact, I think the greatest opposition comes from the competitors of JAMA, not from other advertisers."

"The Pfizer ad is a decided relief from the rest of the magazine. It is the only bright spot in the book. The rest of JAMA should come up to it, both editorially and productionwise. It is probably the only thing in JAMA that the physician really enjoys."

"It looks as though Pfizer now owns JAMA, but considering the high reputation of JAMA, this isn't too serious a consideration. JAMA must sell space, and this is one way to do it. I have no objections to the Pfizer insert or to the binding-in of an insert of this kind. As a matter of fact, it somewhat dresses up the book. The trouble is, too many people will probably read 'Spectrum' and not JAMA."

Two different medical ad agency people made unfavorable comments about Spectrum:

"This sort of thing can lead to trouble since the AMA is apparently publishing the house organ of Pfizer. Occasional inserts are okay, even as extensive as Spectrum, but should not be done regularly. It is a coup for Pfizer's ad boys, but it is bad for the AMA."

"As for the Pfizer ad, many agencies and manufacturers think that it nullifies the effectiveness of their own ads. It is no answer that they can do the same thing. I'm in favor of anything that will make the doctors more interested in JAMA, but I don't think Spectrum does this. It is also generally felt that there is AMA sponsorship of Pfizer in the sense that clearance was made easier for them."

Three ethical drug manufacturers also made critical comments:

"JAMA has sold out to Pfizer. It has cheapened itself. You get the impression that it will sell the whole magazine if anyone will pay for it."

"The Spectrum ad is deplorable. The whole principle of accepting large inserts from big companies is bad. Suppose other advertisers wanted to do the same thing? I feel sorry for the AMA. They are prostituting themselves. It doesn't affect us, however."

"The idea of binding a house organ into JAMA is a poor idea because it detracts from the value of the book. However, if inserts of this type are accepted, they should be limited to number of times and pages. Otherwise, JAMA is bound to accept other advertisers' inserts like this, and will become a journal of inserts. In fairness to other advertisers, Spectrum should be dropped or others accepted. The latter would be preposterous."

Other comments were offered regarding other advertising policies. The most frequenly offered one concerned the interspersal of advertising with editorial matter. About a third of the advertisers interviewed definitely stated that they would like to see ads interspersed, since they felt that this would improve the readership of the ads. Roughly another third stated that as advertisers, they would like to see the ads interspersed, but they knew that the physicians would not like this change, so they were willing to go along with the present arrangement. Another third stated that they were satisfied with the present arrangements, and did not want the ads interspersed.

About a quarter of the advertisers felt strongly that there should be an Index of Advertisers. Though a large number of the people we interviewed did not explicitly state their stand on this subject, we received the impression that the addition of an advertiser index would be universally appreciated by the advertisers.

An example of the comments made regarding mixing advertising and editorial matter is the following comment by an ethical drug manufacturer:

"It's difficult to say what to do about the position of the ads. From the advertisers' point of view, of course, they should be interspersed. But from the doctors' point of view, they are better as they are. You would probably spoil the high standard and professional integrity of JAMA if you interspersed the ads."

This suggestion, made by a medical equipment manufacturer, was also made by several others:

"The Table of Contents is good on the cover. It could be made a little more artistic. If the book goes only to the GP, it is satisfactory as it is. But if it also goes to the specialist, the book should be divided into sections: compare it to Time magazine-that's sectionalized-national affairs, foreign affairs, etc.

"JAMA could then be sectionalized by specialty. This applies both to the editorial matter and to the ads. It would then be possible to have the editorial matter more closely positioned to the ads."

A list of the individuals and firms whose opinions are represented in this report follows.

APPENDIX

Companies and individuals interviewed

Company

Abbott Laboratories, North Chicago,
Ill.

W. D. Allison Co., Indianapolis, Ind..
American Home Foods, Inc., New York,
N.Y.

American Meat Institute, Chicago, Ill...
American Pharmaceutical Co., New
York, N.Y.

Ames Co., Inc., New York, N.Y.
Armour Laboratories, Chicago, Ill..
Ayerst McKenna & Harrison, Ltd.,
New York, N.Y.

Batten, Barton, Durstine & Osborn,
Inc., New York, N.Y.
Bauer & Black, Chicago, I....
Back Lee Corp., Chicago, Ill..

Dr. S. H. Blackberg, Chicago, Ill.....
Borchardt Malt Extract Co., Chicago,
Ill.

Branstater & Associates, Inc., New
York, N.Y.

Burroughs-Wellcome Co., Tuckahoe,

N.Y.

Chilcotte, Morris Plains, N.J..
Ciba Pharmaceutical Products, Sum-
mit, N.J.

Clay-Adams Co., Inc., New York, N. Y..
Commercial Solvents, New York, N.Y..
Doherty Clifford & Shenfield, Inc., New
York, N.Y.

Edison Chemical Co., Chicago, Ill.
Cortez F. Enlee, Inc., New York, N.Y..
Ethicon Suture Laboratories, New
Brunswick, N.J.

Fellows Medical Manufacturing Co.,
New York, N.Y.

B. Fougera & Co., New York, N.Y.
L. W. Frolich & Co., Inc., New York,
N.Y.

Geigy Co., Inc., New York, N.Y
Gray & Rogers, Philadelphia, Pa.
Grune & Stratton, Inc., New York, N. Y.
Harrower Laboratories, Jersey City, N.J.
Arthur D. Herrick, consultant, New
York, N.Y.

Vice president.

Advertising manager.

Do.

Vice president.

Dr. L. G. Maison..

President.

Companies and individuals interviewed-Continued