Advertising, ethics and the competitive practice of medicine: Charles Elton Blanchard MD
- Correspondence to: Professor D Neuhauser Department of Epidemiology and Biostatistics, Medical School, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4945, USA;
On 2 May 1902 Charles Elton Blanchard and 34 other students graduated from the medical school which is now called Case Western Reserve University in Cleveland, Ohio. The Dean said “The class of 1902 will be heard from”.1 Dr. Blanchard did his best to fulfil this prediction writing 20 books in his lifetime, mostly published by the press he owned. He was ultimately forgotten, thus failing to fulfil the Dean’s promise.
It took Blanchard 6 years to complete medical school because he had no money. He had to work writing advertising copy and at other jobs. When he graduated he did not have enough money to rent office space and open a practice so he worked as a drug company sales representative to doctors, travelling the midwest, learning from practitioners, and saving his money. “It was a royal experience … my heart warms up to the American doctor”.1
He saved enough money to buy the Cleveland Emergency Hospital for $4000. He had $7.50 in cash, a friend loaned him $150, he put down $100, and promised to pay the rest at $200 a month. This is when the trouble started. With this hospital Blanchard bought what today would be called a Health Maintenance Organization (HMO). About 5000 company workers and their families paid $2–5 each year in exchange for all the medical care they needed. This is called capitation. “It looked like a good scheme to me … and the amount I had paid for it was but a fraction of what the institution had cost. Besides it smacked of humanitarianism—it was a cooperative brotherhood hospital.” The problem was that then the American Medical Association’s code of ethics said that such capitation practices were unethical. Dr Blanchard’s application to become a member of the local medical society was …