In the half century I have been hanging along the fringes of medicine, I have seen many changes. One change was the radical move from ethics that prohibited doctors from boasting about their prowess to contemporary premises that a physician group or hospital must advertise its products in this competitive environment.
In another of these essays, I wrote about how the American College of Radiology (ACR) was persuaded to tell the public that those lead-robed folks in dark basement rooms were physicians with medical skills essential to modern medicine. One of the elements of the new program was to provide press coverage programs for the American Roentgen Ray Society, the Radiological Society of North America, the American Radium Society, and the Canadian Association of Radiologists.
This was one of the chores I got when I became the ACR director of public relations in 1961. I got advance programs and wrote to speakers asking for a copy of their papers. I would grind my way through those who cooperated and pick the ones I thought would make news. Among the early ones I picked were Robert L. Egan’s reports on mammography technique, Charles Dotter’s angiography and angioplasty adventures, the use of hyperbaric chambers to enhance tumor response to radiation, Roslyn Yalow’s development of radioimmunoassays, the proliferation of technetium-99 as the isotope of choice for imaging most body organs, and a steady stream of observational reports on x-ray signs.
It was alright to brag about radiology, so long as the bragging was done by professional societies. In a few instances, we quashed press interest in which a speaker sent out his own press release with claims that were false. I recall one claim of a cure for cancer based on the survival of three mice. It helped our respectability if we were honest about flaws as well as triumphs.
Then the rules changed for all of medicine. A Virginia lawyer sued his professional society for setting fees and insisting that individuals could not make their own decisions. The suit bounced all the way to the US Supreme Court. The court ruled that professional societies were subject to anti-trust laws and could not tell their members that self-aggrandisement was unethical. This came along about the same time that various forms of managed care were developing. Those new enterprises advertised themselves as the saviors of health care. As for-profit hospital chains gobbled up community institutions, they, too, assured their communities that their hospital was the best of the pack. When health planning laws curtailed hospital expansion, including the purchase of expensive equipment such as computed tomographic scanners, magnetic resonance imaging units, and linear accelerators, many radiology groups obtained their own equipment, positioned it outside of the hospital and encouraged the great unwashed herd to patronize the free-standing facilities.
In response to all of these changes, the ACR developed marketing programs for radiology groups to adapt to their community uses. Again, the implication was that anyone who failed to promote his or her own enterprise soon would have nothing to promote. When others besides radiologists got into the imaging business, the historic restraints on claims of bigger and better and more accomodating facilities disappeared. Then came the flurry of centers that urged the worried wealthy to drop in for a whole-body computed tomographic screening exercise.
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