Regulating quack medicine

Abstract

Quack medicines were prepackaged, commercially marketed medicinal concoctions brewed from “secret recipes” that often contained powerful drugs. Governmental regulation of them in late nineteenth-century England is heralded as a landmark of public health policy. We argue that it’s instead a landmark of medicinal rent-seeking. We develop a theory of quack medicine regulation in Victorian England according to which health professionals faced growing competition from close substitutes: quack medicine vendors. To protect their rents, health professionals organized, lobbied, and won laws granting them a monopoly over the sale of “poisonous” medicaments, most notably, quack medicines.

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Notes

  1. 1.

    However, under the Medicine Stamp Act, the seller had to pay a tax: an annual fee and an ad valorem duty on the medicine. See Stebbings (2013).

  2. 2.

    The relationship between active versus passive state predation and “state capacity” depends on what, precisely, is meant by “state capacity”—a troublesome term used in various ways, including in the literature on “state capacity.” For a critical review of that literature, see Piano (2019).

  3. 3.

    The Surgeons Company formerly was the Barber Surgeons Company and later the College of Surgeons.

  4. 4.

    Registered pharmacists acquired exclusive right to use the title “pharmaceutical chemist” in 1852. They acquired exclusive right to use an encompassing list of related of titles in 1868.

  5. 5.

    This is not to trivialize the stethoscope, anesthesia, sterilization, or x-rays, each of which was invented/discovered in the nineteenth century (see Bynum 1994). But they did not particularly advance disease theory or therapeutics. Smallpox inoculation, discovered in the late eighteenth century, is an important exception.

  6. 6.

    Bloodletting, whose therapeutic popularity waned over time, also was still used occasionally in the late nineteenth century.

  7. 7.

    Our theory of health-professional rents turns the conventional theory on its head. In the latter, professionals’ expertise gives them an informational advantage over consumers, which professionals can exploit. State intervention in the healthcare market prevents health professionals from earning rents. In our theory, health professionals have no real expertise, no important informational advantage over consumers to exploit. State intervention in the healthcare market enables health professionals to earn rents.

  8. 8.

    The former originally was called the Provincial Medical and Surgical Association.

  9. 9.

    Formerly, the Pharmaceutical Journal and Transactions and Pharmaceutical Transactions.

  10. 10.

    Organized professional healthcare shared common cause when it came to quack medicine vendors. But relations between the British Medical Association and the Pharmaceutical Society, and doctors and pharmacists more generally, were not always, or perhaps even often, harmonious. The reason is that their interests, though overlapping, were distinct and not infrequently opposed. Just as both groups of health professionals competed with quack medicine vendors, they competed with each other. Pharmacists were wont to “counter prescribe”, poaching on doctors’ advising privilege, much as the old apothecaries had done, but also on doctors’ dispensing practice, which, while diminishing in the nineteenth century, remained an important source of income. Doctors were eager to exclude chemists and druggists from such activity—if possible, to require their prescriptions for pharmacists to supply drugs and medicine. Within each healthcare profession, members’ interests likewise could diverge. Conflicts between pharmacists, for example, led temporarily to the creation of a rival professional organization, the United Society of Chemists and Druggists. Even still, disagreements could be, and at critical junctures were, set aside to address a common problem: quack medicine vendors.

  11. 11.

    An earlier, though very modest, achievement that touched on medicine—but just barely—was the Arsenic Act of 1851. Another earlier, modest achievement was the Pharmacy Act of 1852, which gave persons registered under that Act exclusive right to the title “pharmaceutical chemist”.

  12. 12.

    Pharmacists were divided on the inclusion of opium—an example of divergent interests within that healthcare profession. On the one hand, opium was the poisonous medicament most likely to be resorted to for self-treatment. Thus, for many pharmacists, a monopoly would be extremely valuable. On the other hand, the Pharmacy Act imposed costly requirements on the drugs it covered: labeling and, for those in the first part of the schedule, recordkeeping, which might also drive some consumers away. For pharmacists located in places with few other medicinal retailers, the benefit of the monopoly could be outweighed by the cost of the Act’s other requirements. That observation may explain why the first iteration of the Pharmacy Act included opium but a subsequent iteration did not, the drug having “been removed from…the poison schedule…to placate Lincolnshire, Cambridgeshire and Norfolkshire chemists”, who feared “that the original requirements would have seriously interfered with their business—opium being one of their chief articles of trade” (Lomax 1973, p. 175). Opium reappeared in the Act’s final version, though on the second, less restrictive part of its schedule.

  13. 13.

    Medicines supplied by licensed doctors or dispensed by licensed pharmacists that contained scheduled poisons largely were exempted from these requirements, including the use of a “poison” label.

  14. 14.

    The tax revenue generated from quack medicines perhaps also gave their manufacturers some political clout. See, for instance, King (1844).

  15. 15.

    Such was the defense offered by a seller of a poisonous quack medicine in a previous, though less far-reaching, case, who was prosecuted successfully in 1882 for violating the Pharmacy Act’s labeling requirements.

  16. 16.

    The Arsenic Act of 1851 also declared public safety its purpose, albeit of a different kind: “Whereas the unrestricted sale of arsenic facilitates the commission of crime…” (Pharmacy and Poison Laws 1892, p. 21).

  17. 17.

    Nor is considering the timing of the regulation very helpful for this purpose. On the one hand, in the second half of the nineteenth century, multiple “poisoning scares” arose, which reflected public concern with dangerous substances. On the other hand, in the second half of the nineteenth century, the competition that health professionals faced from quack medicine vendors intensified dramatically.

  18. 18.

    Moreover, at least one contemporary claimed that the Pharmacy Act’s schedule of poisons “omitted mention of many substances more harmful than those it contained” (Pharmacy and Poison Laws 1892, p. 117). The problem of opium poisonings featured prominently in the rhetoric of Victorian health reformers. And, in fact, “Opium poisoning was a commonplace matter” (Berridge and Edwards 1987, p. 79). “As a group”, however, “the pharmacists were unconcerned with the dangers of drug abuse” (Lomax 1973, p. 175). And doctors scarcely more so: “even medical prescriptions ordering opiates and anodynes are frequently presented for dispensing an indefinite number of times with the cognisance of the prescribers” (British Medical Journal 1890, p. 974).

  19. 19.

    Further, it’s telling that the Pharmacy Act’s monopoly extended to all currently practicing pharmacists—without any requirement that they pass a competency exam—but required all future pharmacists to pass such an exam.

  20. 20.

    Doctors, however, took a more positive view—an example of divergent interests between the healthcare professions. The 1863 proposal was put forward by the General Medical Council, the legal examination and registration body for English doctors created by the Medical Act of 1858.

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Correspondence to Peter T. Leeson.

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Leeson thanks Fuente Fuente Opus X for encouragement.

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Leeson, P.T., King, M.S. & Fegley, T.J. Regulating quack medicine. Public Choice 182, 273–286 (2020). https://doi.org/10.1007/s11127-019-00656-w

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Keywords

  • Quack medicine
  • Patent medicine
  • Proprietary medicine
  • Regulation
  • Pharmacy Act
  • Poison
  • Rent-seeking