Cover

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Title Page, Copyright, Dedication

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pp. i-v

Contents

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p. vii

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Preface. A Tale of Two Medicine Bottles

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pp. ix-xiii

A few years ago, while cleaning out the bathroom closet of my childhood home, I found an old prescription bottle. Its label carried simply the date, March 6, 1965, the name and telephone number of the drugstore, my name (misspelled), my home address (correct), my doctor’s name, and these cryptic...

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Acknowledgments

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pp. xv-xviii

In the many years it has taken me to complete this book, I have accumulated more debts than can be properly acknowledged in a few paragraphs. Four scholarly communities have been particularly important in its writing. The first is the National Humanities Center in Research Triangle Park, North Carolina, where I spent...

Abbreviations and Acronyms

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pp. xix-xx

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Introduction: This Isn’t Your Father’s Patient

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pp. 1-16

In 2006, the trade periodical Hospitals and Health Networks carried a special supplement, “Patient Satisfaction and the New Consumer,” prepared by Press Ganey Associates, a health marketing firm. The American patient, the supplement explained, was “more discerning and demanding” than in the past, a “savvy internet...

Part One: The Hazards of New Choices: The 1920s to the 1940s

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1. Farewell to the Free Trade in Doctoring

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pp. 19-47

When today we lament the loss of a “golden age” when the goods of medicine, both real and symbolic, were untouched by the entrepreneurial spirit of modern consumer culture, we mourn a past of our own imagination. The remaking of patients into consumers started not with managed care or the Internet...

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2. The High Cost of Keeping Alive

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pp. 48-76

In 1926, the Saturday Evening Post ran an article, “The High Cost of Keeping Alive,” that described the replacement of the old-style family doctor with a new and better kind of medical man. As physician-author Stanley M. Rinehart explained, “It takes more time, more money and more education to be a doctor...

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3. The New Corner Store

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pp. 77-104

In 1925, writing in the American Mercury, essayist Thomas LeBlanc reflected on the demise of the traveling medicine show. As a boy in rural Michigan, he had looked forward to the annual visit of the Professor and his sidekick, Sambo, to promote Tono Tonic, their “secret compound of roots, herbs, barks, leaves...

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4. The Guinea Pigs’ Revolt

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pp. 105-136

In 1935, an article with the provocative title “Shopping for Medical Care” appeared in the Confidential Bulletin, published by Consumers’ Research, a nonprofit organization set up in 1929 to advocate for consumer interests. “In shopping for medical care it is necessary to be even more skeptical and vigilant than in shopping...

Part Two: Free Enterprise Medicine: The 1940s to the 1960s

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5. The Fourth Necessity

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pp. 139-164

In December 1944, with the end of World War II in sight, the business magazine Fortune carried a lengthy article on “U.S. Medicine in Transition.” It opened with a sharp observation: “Nobody gives a hoot whether or not night clubs or even movies are made cheaply available to all, but people who cannot find or pay...

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6. The MDs Are Off Their Pedestal

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pp. 165-219

In June 1957, Mr. and Mrs. Benjamin Hooper of Manorville, New York, paid a visit to the Suffolk County Medical Society. People of modest means — he drove a truck for the highway department, she was a telephone operator — they came to meet with the society’s medical grievance committee to protest a large...

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7. A Big Pill to Swallow

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pp. 220-248

In the winter of 1951, Washington, D.C., lawyer Walton Hamilton came down with a nasty strep throat. To treat it, his physician prescribed a powerful new antibiotic, Chloromycetin. When he went to fill the prescription, Hamilton was shocked to discover that a four-day supply of the drug cost eight dollars, a steep...

Part Three: A Consumers’ Revolution? The 1960s to the 1990s

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8. The Patient Must Prescribe for the Doctor

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pp. 251-286

In 1966, Walter Goodman, a senior editor at the New York Times, began a lengthy article on the current troubled state of American medicine with the lament, “What ever became of good old doc?” Underneath a photograph of a top-hatted nineteenth-century physician, Goodman mused, “Whereas the relations...

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9. Get Ready for a New Breed of Patients

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pp. 287-320

In 1974, Medical Economics, the journal dedicated to keeping practicing physicians up-to- date, carried an article advising readers to “get ready for a new breed of patients!” Author Donald L. Cooper, the medical director of Oklahoma State University’s Health Center, warned his fellow doctors that new college...

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10. Shopping Mall Medicine

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pp. 321-359

In late 1982, a new building bearing a large blue and white sign, “MedFirst — Physician Care — Open 7 Days a Week,” opened on a busy street in St. Petersburg, Florida, between a shopping center and a McDonald’s. On a Sunday morning that December, the sixteen patients waiting to see the young board-certified family...

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11. Medicine-Chest Roulette

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pp. 360-387

In May 1988, shortly before embarking on its hospital rating venture, U.S. News and World Report carried a sobering article about the nation’s drug supply. But instead of focusing on illegal drugs such as heroin and cocaine, author Steve Findlay directed his readers’ attention to America’s “other drug...

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Conclusion: The Barbarians Are at the Gate

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pp. 388-422

In October 2007, Zagat Survey, well known for its popular restaurant and hotel guides, announced a new venture: a doctor guide to be developed in collaboration with WellPoint, a managed-care company that was now the nation’s largest health-benefits firm. Following the format used in its other guides...

Notes

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pp. 423-472

Bibliography

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pp. 473-518

Index

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pp. 519-539