Commentary Professional Advertising FREDERICK STOCK, DMD "Advertising is like learning-a little is a dangerous thing." -P. T. Barnum
On July 28, 1977 the New York State Board of Regents voted unanimously to permit all professionals, except lawyers and clergymen, to advertise within the State. The revised rules relating to definitions of unprofessional conduct went into effect on October 1, 1977 and apply to all 29 professions governed by the New York State Education Department.1 This is the first time in over half-a-century that professionals have been permitted to advertise legally in New York State. It remains to be seen whether and how advertising will affect the present delivery systems of the various
professions. Throughout its history, the definition of advertising has been a problem. The most reasonable definition may be that suggested by the Harvard Business School: "Advertising includes those activities by which visual or oral messages are addressed to the public for the purposes of informing them and influencing them either to buy merchandise or services or to act or be inclined favorably toward ideas, institutions, or persons features."2 The purpose of advertising, then, is to sell either "goods", ideas, or services, with the objective of causing action and attitude change on the part of the consumer.
Advertising, according to the courts, must be written for the probable effect it produces on "ordinary and trusting minds."3 It must not conceal or obscure material facts, nor distract and divert attention from the true nature of the terms and conditions of an offer. Advertising must be free of fraudulent traps and strategems that induce action that would not result from a forthright disclosure of the true nature of an offer. The issues raised by advertising of the learned professions are legal and professional, and related to the economic Address reprint requests to Dr. Frederick Stock, Bureau of Dental Health, New York State Department of Health, Tower Building, Empire State Plaza, Albany, NY 12237. This paper, submitted to the Journal January 13, 1978, was revised and accepted for publication June 14, 1978. AJPH December 1978, Vol. 68, No. 12
principles of this country. These issues are not new ones. At the turn of the century, advertising by the medical and dental professions was common and, especially for patent medicines, was used to the extreme limits of honesty and acceptability. Medical advertising abuse led advertiser Claude C. Hopkins to remark, "The greatest advertising men of my day were schooled in the medicine field . . ."4 This widespread, blatant abuse caused professional organizations to ban advertising by their members through prohibitions in their "code of ethics." Enforcement of such ethical codes was later solidified by state licensing laws prohibiting advertising by members of the learned professions. These prohibitions have been in effect throughout this century. It is only recently, with the increased awareness and demands of consumerism, that the prohibitions against professional advertising have come under question and attack. In 1914 the Federal Trade Commission (FTC) was established to regulate interstate commerce and assure fair trade practices among interstate business concerns. Section 5 of the FTC Act stated, "Unfair methods of competition in commerce are hereby declared unlawful."5 In this, the FTC was particularly concerned about protecting small business firms rather than consumers. This concern led to the 1938 Wheeler-Lea Amendment which changed this statement to read: "Unfair methods of competition in commerce and unfair or deceptive actions or practices in commerce . . . unlawful."6 Recently the FTC moved into the area of consumer protectionism by making more information available to the public. This led to the 1974 Congressional Magnuson-Moss Warranty-FTC Improvement Act which gave the FTC authority to "prescribe rules which define with specificity acts or practices which are unfair or deceptive acts or practices in or affecting commerce."7 With this new authority, the FTC is now bringing the issue of advertising and the professions before the judicial system. The courts, especially the U.S. Supreme Court, usually side with the FTC and uphold its actions on advertising. FTC and judicial pressures have resulted in a steady movement to force a liberalization of the ethical controls of the past, imposed upon professionals either directly by state leg1 207
COMMENTARY
islative acts or indirectly by professional "codes of ethics." The Supreme Court has been most active in the professions of pharmacy, law, and optometry. One of the first decisions concerning advertising in the professions was Semler v. Oregon State Board of Dental Examiners in 1935. Here the Supreme Court upheld a 1933 Oregon statute prohibiting advertising by dentists as to their "professional superiority or the performance of professional services in a superior manner; advertising prices for professional services; . . . or advertising to guarantee any dental service, or to perform any dental operation painlessly."8 In so ruling against advertising by a dentist on the narrow grounds of his "superior ability" and "painless operations," the court side-stepped the more important issue of whether all forms of advertising by dentists could be prohibited by state statutes. Recently, however, the Supreme Court reversed itself on the Semler "land-mark" decision. A 1976 ruling regarding pharmacists and their codes of ethics cleared the way for competitive advertising of prescription drug prices. In the case of Virginia State Board of Pharmacy v. Virginia Citizens Consumer Council, Inc., it held "commercial speech" to be protected by the First Amendment guarantee of free expression and the Due Process Clause of the Fourteenth Amendment. The opinion stated that consumers had the same standing to assert First Amendment protection as that enjoyed by advertisers. In the words of Justice Harry A. Blackmun, "the pharmacist has the right to transmit and the consumer the right to receive the 'free flow of commercial information.' "9 The Court felt the individual consumer and society in general might have strong interests in the free flow of commercial information. The arguments that advertising would lead to "cutthroat" practices and reduce professionalism were rejected. The Court stated advertising "however tasteless and excessive it sometimes may seem" was indispensible to intelligent public decisions on how to allocate resources."9 In the profession of law, the U.S. Supreme Court declared on June 27, 1977, that the ban on overt solicitation of business by attorneys was illegal. In Bates and O'Steen v. State Bar of Arizona it was stated that the First Amendment guarantee of free speech protects "advertisement of standardized fees" for "routine legal services." 10 The Court upheld the free speech rights of Bates and Van O'Steen by declaring they had the right to state their legal fees in a newspaper advertisement in the Arizona Republic. In so doing, the Supreme Court struck down all state statutes prohibiting lawyers from advertising their service fees. In a dissenting opinion, Justice Lewis F. Powell, Jr., protested that opportunities for deception by unethical lawyers might be expanded with the possibility of simplistic price advertising victimizing the public. But the Court majority felt that advertising by attorneys would make the consumer more effective in the "lawyer marketplace," would introduce competition into the legal profession, and eventually would force a reduction in legal fees. Presently the medical and dental professions are faced with continuing legal and consumer demands for professional service advertising. Both the American Medical Associa1 208
tion and the American Dental Association remain opposed to changing their codes of ethics to permit advertising. The ADA's revised January 1, 1976 "Principles of Ethics," section 12 states: "Advertising reflects adversely on the dentist who employs it and lowers the public esteem of the dental profession. The dentist has the obligation of advancing his reputation for fidelity, judgment and skill solely through the professional services to his patients and to society. The use of advertising in any form to solicit patients is inconsistent with this obligation.""II Because of this position against advertising and the federal government's desire to force increased competition among health professionals, the Federal Trade Commission has moved against the ADA. On January 13, 1977, the FTC issued a complaint against the ADA, the Indiana Dental Association, the Indianapolis District Dental Society, the Virginia Dental Association, and the Northern Virginia District Dental Society alleging violation of federal antitrust laws and Section 5 of the FTC Act which prohibits "unfair methods of competition in commerce, and unfair or deceptive acts or practices in commerce." 12 The FTC holds that the ADA through the publication, distribution, and enforcement of its "Principles of Ethics" prevents dentists from competing fully with one another. Paragraph 12 of the complaint alleges that prohibitions against advertising result in a number of adverse consumer effects which include: 1. Prices of dentist services being stabilized or fixed; 2. Competition among dentists in the provisions of dentist services being hindered, restrained, foreclosed, and frustrated; 3. Consumers of dentist services being deprived of information pertinent to the selection of a dentist and of the benefits of competition; 4. Dentists being restrained in their ability to compete and to make dentist services readily and fully available to consumers; 5. Development of innovative systems for the delivery of dentist services being hindered and restrained. The ADA denied the basic allegations and stated that it has not "fostered any practices nor engaged in any conduct relating to its advertising ethics which is in violation of the Federal Trade Commission Act."' 3 The ADA argued that being a "bona fide" nonprofit organization it is not subject to FTC jurisdiction and is therefore exempt from federal antitrust laws. It feels its "Principles of Ethics" are lawful because "they were the direct result of the ADA's desire to fulfill its public service responsibilities with reference to the maintenance of sound, qualitative standards of dental prac-
tices."'2 The AMA and ADA consider advertising bans necessary to ensure professional competence and to protect the public from exploitation and fraud. Whether such prohibitions do in fact inhibit professional abuses is difficult to assess. Health professionals like to point out the advertising excesses in California where medical and dental advertising has existed for many years. Health organizations feel advertising would not increase competition among health professionals, would not lower prices for patients, and would lead to abuses in the delivery of health care. In fact, since advertising costs might be passed on to the patient, service fees
A1JPH December 1978, Vol. 68, No. 12
COMMENTARY
might increase. A recent study by Darling and Bussom14 found that dentists felt advertising would adversely affect their public image and lead to increased govenment intervention. It was feared that lower quality services might result due to discount pricing by "unscrupulous" practitioners and that larger practitioners might "swallow" smaller ones. The FDA actions and Supreme Court Decisions have led to a number of actions on the part of states. In New York, the New York State Board of Regents voted unanimously to permit all professionals, except lawyers and clergymen-29 professions in all-to advertise. This includes the advertising of both services and prices in newspapers and magazines; only services can be advertised in radio and television. Regent Emlyn I. Griffith, Chairman of the Committee on Professional Discipline, felt advertising of prices on TV would be "most closely identified with the problem of hucksterism" and that "the possibility of abuse seemed to be greater in the electronic media than in the printed media." 15 Since the Supreme Court ruled only on printed advertising in the previously cited Bates Case, the Board of Regents agreed to prohibit price advertising in the electronic media. Other specific prohibitions include feesplitting, exploitation of patients or clients, practicing beyond the scope of an individual's competence, percentage-leasing, and failure to turn over documents and reports to patients, clients, or other practitioners. Advertising that is "sensational or flamboyant," using testimonials, guaranteeing results, or claiming superiority is also barred. Only "factually accurate and dignified" advertising for fixed prices as to "specific, routine professional services" is allowed. Statements specifying additional charges that might be incurred for related services must also be included. A patient's full access to their medical recrods except where this "would adversely affect the patient's health" is also guaranteed. Because New York is the only state with a unified system of professional education, licensure, and discipline, the decision to permit professional advertising may affect how other states handle this issue. Regent Willard A. Genrich, Chairman of the Committee on Higher and Professional Education, felt it is the "first complete comprehensive set of rules on professional conduct anywhere in the nation." 15 Recently Texas ruled against prohibitions banning drug advertisements,16 Tennessee against those for optometry,17 and Maine concerning dental fees.18 Connecticut has also just passed new legislation to take effect on July 1, 1978, allowing consumers for the first time to be represented on all of the professional boards.19 State officials admit that these measures are a result of the rising "mood" of consumerism, the decline in public confidence in the professions, and the alleged abuses by medical, dental, and legal professionals. Opinions about professional advertising reflect the differences in perspective and basic philosophy between various professional groups and the federal courts and regulatory agencies. It appears from a legal standpoint, as in the Bates-O'Sheen case, that the rights of "commercial free speech" under the First and Fourteenth Amendments are now being expanded into the area of professional services. With the example of New York State, legislative action can AJPH December 1978, Vol. 68, No. 12
be expected to permit professional advertising in other states. Because of the increased concern and pressure on the part of the consumers "to know" and acquire adequate information about professional services, it is conceivable that advertising will play a valuable role as a means of communicating and disseminating information. Historically, advertising has been considered an integral part of a private enterprise economy. Reasons for the initiation of professional advertising bans may have been valid 50 years ago, but today's reality of high service costs, as exemplified by the 300 per cent increase in health care costs between 1960 and 1975, has forced reconsideration of advertising as a "cost-control" mechanism. In the area of health care, a "free-enterprise" economy dominates the health service delivery system in the United States. Other western, industrialized countries consider health care independent of "free-market" variables and control it to varying degrees on federal levels. Since this country continues to treat health care as another marketable commodity, it is understandable that advertising, a viable method of merchandising, might be used as an attempt to contain professional service costs. The federal government hopes professional advertising will result in increased competition with the elimination of indirect "price-fixing." It remains to be seen if advertising which governs the "product marketplace" can be applied successfully to professional services operating within that same "free enterprise" environment.
REFERENCES 1. Section 29.1 of Title 8 of the Official Compilation of Codes, Rules and Regulations of the State of New York. 2. Wood JP: The Story of Advertising, New York: The Ronald Press Co., 1958. 3. Burton PW and Miller JR: Advertising Fundamentals, Scranton, PA: International Textbook Co., 1970. 4. Turner ES: The Shocking History of Advertising, London: Michael Joseph Ltd., 1952. 5. Federal Trade Commission Act, 38 Stat. 717, (1914). 6. Federal Trade Commission Act, 52 Stat. 111, (1938). 7. Magnuson-Moss Warranty-Federal Trade Commission Improvement Act, P.L. 93-637; 88 Stat. 2183, (1974). 8. Semler v. Oregon State Board of Dental Examiners, 294 US 608, 609, (1935). 9. Virginia State Board of Pharmacy et al v. Virginia Citizens Consumer Council, Inc., et al, 425 US 748, (1976). 10. Bates and O'Steen v. State Bar of Arizona, 97 SCt 2691, (1977). 11. Principles of Ethics, American Dental Association, Chicago, Ill., January 1, 1976. 12. Journal of the American Dental Association, 94:1261, 1264, June 1977. 13. Watkins RW: Washington Report, Dental Survey, Minneapolis, MN, 53:22, 1977. 14. Darling JR and Busson RS: A comparative analysis of the attitudes of dentists toward the advertising of their fees and services. J. Dent. Ed. 41:59-67, 1977. 15. Meislin RJ: New York regents vote to allow doctors and dentists to advertise, The New York Times, New York, p. Al, B2, July 29, 1977. 16. Texas State Board of Pharmacy v. Gibson's Discount Center, 541 SW 2d 884, (1976). 17. Horner-Rausch Optical Company et al v. R. A. Ashley, Jr., et al, 547 SW 2d 577, (1977). 18. 1977 Me. Legis. Serv., Chapter 458. 19. 1977 Conn. Pub. Acts 77-614.
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On July 28, 1977 the New York State Board of Regents voted unanimously to permit all professionals, except lawyers and clergymen, to advertise within the State. The revised rules relating to definitions of unprofessional conduct went into effect on October 1, 1977 and apply to all 29 professions governed by the New York State Education Department.1 This is the first time in over half-a-century that professionals have been permitted to advertise legally in New York State. It remains to be seen whether and how advertising will affect the present delivery systems of the various
professions. Throughout its history, the definition of advertising has been a problem. The most reasonable definition may be that suggested by the Harvard Business School: "Advertising includes those activities by which visual or oral messages are addressed to the public for the purposes of informing them and influencing them either to buy merchandise or services or to act or be inclined favorably toward ideas, institutions, or persons features."2 The purpose of advertising, then, is to sell either "goods", ideas, or services, with the objective of causing action and attitude change on the part of the consumer.
Advertising, according to the courts, must be written for the probable effect it produces on "ordinary and trusting minds."3 It must not conceal or obscure material facts, nor distract and divert attention from the true nature of the terms and conditions of an offer. Advertising must be free of fraudulent traps and strategems that induce action that would not result from a forthright disclosure of the true nature of an offer. The issues raised by advertising of the learned professions are legal and professional, and related to the economic Address reprint requests to Dr. Frederick Stock, Bureau of Dental Health, New York State Department of Health, Tower Building, Empire State Plaza, Albany, NY 12237. This paper, submitted to the Journal January 13, 1978, was revised and accepted for publication June 14, 1978. AJPH December 1978, Vol. 68, No. 12
principles of this country. These issues are not new ones. At the turn of the century, advertising by the medical and dental professions was common and, especially for patent medicines, was used to the extreme limits of honesty and acceptability. Medical advertising abuse led advertiser Claude C. Hopkins to remark, "The greatest advertising men of my day were schooled in the medicine field . . ."4 This widespread, blatant abuse caused professional organizations to ban advertising by their members through prohibitions in their "code of ethics." Enforcement of such ethical codes was later solidified by state licensing laws prohibiting advertising by members of the learned professions. These prohibitions have been in effect throughout this century. It is only recently, with the increased awareness and demands of consumerism, that the prohibitions against professional advertising have come under question and attack. In 1914 the Federal Trade Commission (FTC) was established to regulate interstate commerce and assure fair trade practices among interstate business concerns. Section 5 of the FTC Act stated, "Unfair methods of competition in commerce are hereby declared unlawful."5 In this, the FTC was particularly concerned about protecting small business firms rather than consumers. This concern led to the 1938 Wheeler-Lea Amendment which changed this statement to read: "Unfair methods of competition in commerce and unfair or deceptive actions or practices in commerce . . . unlawful."6 Recently the FTC moved into the area of consumer protectionism by making more information available to the public. This led to the 1974 Congressional Magnuson-Moss Warranty-FTC Improvement Act which gave the FTC authority to "prescribe rules which define with specificity acts or practices which are unfair or deceptive acts or practices in or affecting commerce."7 With this new authority, the FTC is now bringing the issue of advertising and the professions before the judicial system. The courts, especially the U.S. Supreme Court, usually side with the FTC and uphold its actions on advertising. FTC and judicial pressures have resulted in a steady movement to force a liberalization of the ethical controls of the past, imposed upon professionals either directly by state leg1 207
COMMENTARY
islative acts or indirectly by professional "codes of ethics." The Supreme Court has been most active in the professions of pharmacy, law, and optometry. One of the first decisions concerning advertising in the professions was Semler v. Oregon State Board of Dental Examiners in 1935. Here the Supreme Court upheld a 1933 Oregon statute prohibiting advertising by dentists as to their "professional superiority or the performance of professional services in a superior manner; advertising prices for professional services; . . . or advertising to guarantee any dental service, or to perform any dental operation painlessly."8 In so ruling against advertising by a dentist on the narrow grounds of his "superior ability" and "painless operations," the court side-stepped the more important issue of whether all forms of advertising by dentists could be prohibited by state statutes. Recently, however, the Supreme Court reversed itself on the Semler "land-mark" decision. A 1976 ruling regarding pharmacists and their codes of ethics cleared the way for competitive advertising of prescription drug prices. In the case of Virginia State Board of Pharmacy v. Virginia Citizens Consumer Council, Inc., it held "commercial speech" to be protected by the First Amendment guarantee of free expression and the Due Process Clause of the Fourteenth Amendment. The opinion stated that consumers had the same standing to assert First Amendment protection as that enjoyed by advertisers. In the words of Justice Harry A. Blackmun, "the pharmacist has the right to transmit and the consumer the right to receive the 'free flow of commercial information.' "9 The Court felt the individual consumer and society in general might have strong interests in the free flow of commercial information. The arguments that advertising would lead to "cutthroat" practices and reduce professionalism were rejected. The Court stated advertising "however tasteless and excessive it sometimes may seem" was indispensible to intelligent public decisions on how to allocate resources."9 In the profession of law, the U.S. Supreme Court declared on June 27, 1977, that the ban on overt solicitation of business by attorneys was illegal. In Bates and O'Steen v. State Bar of Arizona it was stated that the First Amendment guarantee of free speech protects "advertisement of standardized fees" for "routine legal services." 10 The Court upheld the free speech rights of Bates and Van O'Steen by declaring they had the right to state their legal fees in a newspaper advertisement in the Arizona Republic. In so doing, the Supreme Court struck down all state statutes prohibiting lawyers from advertising their service fees. In a dissenting opinion, Justice Lewis F. Powell, Jr., protested that opportunities for deception by unethical lawyers might be expanded with the possibility of simplistic price advertising victimizing the public. But the Court majority felt that advertising by attorneys would make the consumer more effective in the "lawyer marketplace," would introduce competition into the legal profession, and eventually would force a reduction in legal fees. Presently the medical and dental professions are faced with continuing legal and consumer demands for professional service advertising. Both the American Medical Associa1 208
tion and the American Dental Association remain opposed to changing their codes of ethics to permit advertising. The ADA's revised January 1, 1976 "Principles of Ethics," section 12 states: "Advertising reflects adversely on the dentist who employs it and lowers the public esteem of the dental profession. The dentist has the obligation of advancing his reputation for fidelity, judgment and skill solely through the professional services to his patients and to society. The use of advertising in any form to solicit patients is inconsistent with this obligation.""II Because of this position against advertising and the federal government's desire to force increased competition among health professionals, the Federal Trade Commission has moved against the ADA. On January 13, 1977, the FTC issued a complaint against the ADA, the Indiana Dental Association, the Indianapolis District Dental Society, the Virginia Dental Association, and the Northern Virginia District Dental Society alleging violation of federal antitrust laws and Section 5 of the FTC Act which prohibits "unfair methods of competition in commerce, and unfair or deceptive acts or practices in commerce." 12 The FTC holds that the ADA through the publication, distribution, and enforcement of its "Principles of Ethics" prevents dentists from competing fully with one another. Paragraph 12 of the complaint alleges that prohibitions against advertising result in a number of adverse consumer effects which include: 1. Prices of dentist services being stabilized or fixed; 2. Competition among dentists in the provisions of dentist services being hindered, restrained, foreclosed, and frustrated; 3. Consumers of dentist services being deprived of information pertinent to the selection of a dentist and of the benefits of competition; 4. Dentists being restrained in their ability to compete and to make dentist services readily and fully available to consumers; 5. Development of innovative systems for the delivery of dentist services being hindered and restrained. The ADA denied the basic allegations and stated that it has not "fostered any practices nor engaged in any conduct relating to its advertising ethics which is in violation of the Federal Trade Commission Act."' 3 The ADA argued that being a "bona fide" nonprofit organization it is not subject to FTC jurisdiction and is therefore exempt from federal antitrust laws. It feels its "Principles of Ethics" are lawful because "they were the direct result of the ADA's desire to fulfill its public service responsibilities with reference to the maintenance of sound, qualitative standards of dental prac-
tices."'2 The AMA and ADA consider advertising bans necessary to ensure professional competence and to protect the public from exploitation and fraud. Whether such prohibitions do in fact inhibit professional abuses is difficult to assess. Health professionals like to point out the advertising excesses in California where medical and dental advertising has existed for many years. Health organizations feel advertising would not increase competition among health professionals, would not lower prices for patients, and would lead to abuses in the delivery of health care. In fact, since advertising costs might be passed on to the patient, service fees
A1JPH December 1978, Vol. 68, No. 12
COMMENTARY
might increase. A recent study by Darling and Bussom14 found that dentists felt advertising would adversely affect their public image and lead to increased govenment intervention. It was feared that lower quality services might result due to discount pricing by "unscrupulous" practitioners and that larger practitioners might "swallow" smaller ones. The FDA actions and Supreme Court Decisions have led to a number of actions on the part of states. In New York, the New York State Board of Regents voted unanimously to permit all professionals, except lawyers and clergymen-29 professions in all-to advertise. This includes the advertising of both services and prices in newspapers and magazines; only services can be advertised in radio and television. Regent Emlyn I. Griffith, Chairman of the Committee on Professional Discipline, felt advertising of prices on TV would be "most closely identified with the problem of hucksterism" and that "the possibility of abuse seemed to be greater in the electronic media than in the printed media." 15 Since the Supreme Court ruled only on printed advertising in the previously cited Bates Case, the Board of Regents agreed to prohibit price advertising in the electronic media. Other specific prohibitions include feesplitting, exploitation of patients or clients, practicing beyond the scope of an individual's competence, percentage-leasing, and failure to turn over documents and reports to patients, clients, or other practitioners. Advertising that is "sensational or flamboyant," using testimonials, guaranteeing results, or claiming superiority is also barred. Only "factually accurate and dignified" advertising for fixed prices as to "specific, routine professional services" is allowed. Statements specifying additional charges that might be incurred for related services must also be included. A patient's full access to their medical recrods except where this "would adversely affect the patient's health" is also guaranteed. Because New York is the only state with a unified system of professional education, licensure, and discipline, the decision to permit professional advertising may affect how other states handle this issue. Regent Willard A. Genrich, Chairman of the Committee on Higher and Professional Education, felt it is the "first complete comprehensive set of rules on professional conduct anywhere in the nation." 15 Recently Texas ruled against prohibitions banning drug advertisements,16 Tennessee against those for optometry,17 and Maine concerning dental fees.18 Connecticut has also just passed new legislation to take effect on July 1, 1978, allowing consumers for the first time to be represented on all of the professional boards.19 State officials admit that these measures are a result of the rising "mood" of consumerism, the decline in public confidence in the professions, and the alleged abuses by medical, dental, and legal professionals. Opinions about professional advertising reflect the differences in perspective and basic philosophy between various professional groups and the federal courts and regulatory agencies. It appears from a legal standpoint, as in the Bates-O'Sheen case, that the rights of "commercial free speech" under the First and Fourteenth Amendments are now being expanded into the area of professional services. With the example of New York State, legislative action can AJPH December 1978, Vol. 68, No. 12
be expected to permit professional advertising in other states. Because of the increased concern and pressure on the part of the consumers "to know" and acquire adequate information about professional services, it is conceivable that advertising will play a valuable role as a means of communicating and disseminating information. Historically, advertising has been considered an integral part of a private enterprise economy. Reasons for the initiation of professional advertising bans may have been valid 50 years ago, but today's reality of high service costs, as exemplified by the 300 per cent increase in health care costs between 1960 and 1975, has forced reconsideration of advertising as a "cost-control" mechanism. In the area of health care, a "free-enterprise" economy dominates the health service delivery system in the United States. Other western, industrialized countries consider health care independent of "free-market" variables and control it to varying degrees on federal levels. Since this country continues to treat health care as another marketable commodity, it is understandable that advertising, a viable method of merchandising, might be used as an attempt to contain professional service costs. The federal government hopes professional advertising will result in increased competition with the elimination of indirect "price-fixing." It remains to be seen if advertising which governs the "product marketplace" can be applied successfully to professional services operating within that same "free enterprise" environment.
REFERENCES 1. Section 29.1 of Title 8 of the Official Compilation of Codes, Rules and Regulations of the State of New York. 2. Wood JP: The Story of Advertising, New York: The Ronald Press Co., 1958. 3. Burton PW and Miller JR: Advertising Fundamentals, Scranton, PA: International Textbook Co., 1970. 4. Turner ES: The Shocking History of Advertising, London: Michael Joseph Ltd., 1952. 5. Federal Trade Commission Act, 38 Stat. 717, (1914). 6. Federal Trade Commission Act, 52 Stat. 111, (1938). 7. Magnuson-Moss Warranty-Federal Trade Commission Improvement Act, P.L. 93-637; 88 Stat. 2183, (1974). 8. Semler v. Oregon State Board of Dental Examiners, 294 US 608, 609, (1935). 9. Virginia State Board of Pharmacy et al v. Virginia Citizens Consumer Council, Inc., et al, 425 US 748, (1976). 10. Bates and O'Steen v. State Bar of Arizona, 97 SCt 2691, (1977). 11. Principles of Ethics, American Dental Association, Chicago, Ill., January 1, 1976. 12. Journal of the American Dental Association, 94:1261, 1264, June 1977. 13. Watkins RW: Washington Report, Dental Survey, Minneapolis, MN, 53:22, 1977. 14. Darling JR and Busson RS: A comparative analysis of the attitudes of dentists toward the advertising of their fees and services. J. Dent. Ed. 41:59-67, 1977. 15. Meislin RJ: New York regents vote to allow doctors and dentists to advertise, The New York Times, New York, p. Al, B2, July 29, 1977. 16. Texas State Board of Pharmacy v. Gibson's Discount Center, 541 SW 2d 884, (1976). 17. Horner-Rausch Optical Company et al v. R. A. Ashley, Jr., et al, 547 SW 2d 577, (1977). 18. 1977 Me. Legis. Serv., Chapter 458. 19. 1977 Conn. Pub. Acts 77-614.
1209
