Historical Background

Physicians participate in markets, but traditionally orient themselves by ethical standards that go beyond economic behavior.

THE ORIGINS OF PROFESSIONALISM. Modern professional organizations, defined by their codes of ethics and regulating themselves by ethical principles, take their origin from the Aesculapian societies of the fourth century b.c.e. and in particular from the oath of the Greek physician Hippocrates, which bound its members to ethical standards that did not apply to society as a whole. The Hippocratic oath emphasized the principle of patient benefit, placing the patient at the center of the physician's attention.

By the nineteenth century, when the British Medical Association (BMA) and the American Medical Association (AMA) were founded, the concept of a profession organized around explicit standards of ethics was well established. Prohibitions against advertising were among the first professional standards because treatments based on scientific knowledge distinguished physicians from their main competitors, itinerant nostrum salesmen promoting often dubious products with even more dubious promotional claims. Advertising was expressly prohibited as unprofessional and undignified in virtually all countries in which physicians had established their professional identity through professional associations such as the BMA and AMA, which were organized around a code of ethics (Havighurst; Dyer, 1985). Although the actual license to practice is granted and regulated by the state, the task of enforcing the ethics codes falls to the professional associations or the specialty societies.

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