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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
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).
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).
The Surgeons Company formerly was the Barber Surgeons Company and later the College of Surgeons.
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.
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.
Bloodletting, whose therapeutic popularity waned over time, also was still used occasionally in the late nineteenth century.
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.
The former originally was called the Provincial Medical and Surgical Association.
Formerly, the Pharmaceutical Journal and Transactions and Pharmaceutical Transactions.
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.
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”.
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.
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.
The tax revenue generated from quack medicines perhaps also gave their manufacturers some political clout. See, for instance, King (1844).
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.
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).
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.
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).
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.
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.
References
Anderson, S. (2006). From ‘bespoke’ to ‘off-the-peg’: Community pharmacists and the retailing of medicines in Great Britain 1900–1970. In L. H. Curth (Ed.), From physick to pharmacology: Five hundred years of British drug retailing (pp. 105–142). New York: Routledge.
Bell, J., & Redwood, T. (1880). Historical sketch of the progress of pharmacy in Great Britain. London: Printed for the Pharmaceutical Society of Great Britain.
Berridge, V., & Edwards, G. (1987). Opium and the people: Opiate use in nineteenth-century England. New Haven: Yale University Press.
Brennan, G., & Buchanan, J. M. (1980). The power to tax: Analytical foundations of a fiscal constitution. Cambridge: Cambridge University Press.
British Medical Journal. (1890). Parliamentary bills committee. British Medical Journal,2, 973–977.
British Medical Journal. (1893). The patent medicine abuse. British Medical Journal,1, 367.
Brown, P. S. (1987). Social context and medical theory in the demarcation of nineteenth-century boundaries. In W. F. Bynum & R. Porter (Eds.), Medical fringe and medical orthodoxy, 1750–1850 (pp. 216–233). London: Croom Helm.
Brown, M. (2007). Medicine, quackery and the free market: The ‘war’ against Morison’s Pills and the construction of the medical profession, c.1830–c.1850. In M. S. R. Jenner & P. Wallis (Eds.), Medicine and the market in England its colonies, c.1450–c.1850 (pp. 238–261). New York: Palgrave Macmillan.
Burnby, J. G. L. (1997). The preparers and distributors of english proprietary medicines. Dental Historian,32, 47–55.
Bynum, W. F. (1994). Science and the practice of medicine in the nineteenth century. Cambridge: Cambridge University Press.
Carlisle, F. H. (1819). A letter from the Earl of Carlisle to the Rev. William Vernon…on the subject of a bill for establishing regulations for the sale of poisonous drugs…. London: William Clarke, New Bond Street.
Chemist and Druggist. (1892). Poisonous proprietary medicines. Chemist and Druggist,41, 289.
Chemist and Druggist. (1911). Deaths. Chemist and Druggist,78, 41.
High, J., & Coppin, C. A. (1988). Wiley and the whisky industry: Strategic behavior in the passage of the Pure Food Act. Business History Review,69, 286–309.
Holloway, S. W. F. (1987). The orthodox fringe: The origins of the Pharmaceutical Society of Great Britain”. In W. F. Bynum & R. Porter (Eds.), Medical fringe and medical orthodoxy, 1750–1850 (pp. 129–157). London: Croom Helm.
Holloway, S. W. F. (1991). Royal Pharmaceutical Society of Great Britain, 1841–1991. London: Pharmaceutical Press.
Horman, P. G., Hudson, B., & Rowe, R. C. (2007). Popular medicines: An illustrated history. London: Pharmaceutical Press.
Johns, A. (2009). Piracy: The intellectual property wars from Gutenberg to Gates. Chicago: University of Chicago Press.
Kamath, S. J. (1989). Concealed takings: Capture and rent-seeking in the Indian sugar industry. Public Choice,62, 119–138.
King, G. (1844). Sale of quack medicines. Provincial Medical and Surgical Journal,8, 596–597.
Lancet. (1864). The Medical Act. Lancet,1, 26.
Libecap, G. D. (1992). The rise of the Chicago packers and the origins of meat inspection and antitrust. Economic Inquiry,30, 242–262.
Lomax, E. (1973). The uses and abuses of opiates in nineteenth-century England. Bulletin of the History of Medicine,47, 167–176.
Mackintosh, A. (2018). The patent medicines industry in Georgian England: Constructing the market by the potency of print. Cham, Switzerland: Palgrave Macmillan.
Marland, H. (2006). The ‘doctor’s shop’: The rise of the chemist and druggist in nineteenth-century manufacturing districts. In L. H. Curth (Ed.), From physick to pharmacology: Five hundred years of British drug retailing (pp. 79–104). New York: Routledge.
Pharmaceutical Journal and Transactions. (1855). North British branch of the Pharmaceutical Society. Pharmaceutical Journal and Transactions,19, 306–311.
Pharmaceutical Journal and Transactions. (1857). Report of the council. Pharmaceutical Journal and Transactions,16, 593–598.
Pharmaceutical Journal and Transactions. (1864). Opposition to free trade. Pharmaceutical Journal and Transactions, Second Series,6, 610.
Pharmaceutical Journal and Transactions. (1866). Our position and prospects with reference to legislation. Pharmaceutical Journal and Transactions, Second Series,7, 537–539.
Pharmacy and Poison Laws. (1892). The pharmacy and poison laws of Great Britain: Their history and interpretation…. London: Office of “the Chemist and Druggist”.
Piano, E. E. (2019). State capacity and public choice: A critical survey. Public Choice,178, 289–309.
Poelmans, E., Dove, J. A., & Taylor, J. E. (2018). The politics of beer: Analysis of the congressional votes on the Beer Bill of 1933. Public Choice,174, 81–106.
Porter, R. (1989). Health for sale: Quackery in England, 1660–1850. Manchester: Manchester University Press.
Porter, R. (1995). Disease, medicine and society in England, 1550–1860. Cambridge: Cambridge University Press.
Shughart, W. F., II (Ed.). (1997). Taxing choice: The predatory politics of fiscal discrimination. New Brunswick, NJ: Transaction Publishers.
Stebbings, C. (2013). Tax and quacks: The policy of the eighteenth-century medicine stamp duty. In J. Tiley (Ed.), Studies in the history of Tax Law (Vol. 6, pp. 283–304). Portland: Hart.
Stigler, G. J. (1971). The theory of economic regulation. Bell Journal of Economics and Management Science,2, 3–21.
Temin, P. (1979). The origin of compulsory drug prescriptions. Journal of Law and Economics,22, 91–105.
Thomas, D. W., & Leeson, P. T. (2012). The brewer, the baker, and the monopoly maker. Journal of Entrepreneurship and Public Policy,1, 84–95.
Tollison, R. D. (1991). Regulation and interest groups. In J. High (Ed.), Regulation: Economic theory and history (pp. 59–76). Ann Arbor: University of Michigan Press.
Tollison, R. D., & Wagner, R. E. (1991). Self-interest, public interest, and public health. Public Choice,3, 323–343.
Vahabi, M. (2016). A positive theory of the predatory state. Public Choice,168, 153–175.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Leeson thanks Fuente Fuente Opus X for encouragement.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11127-019-00656-w