In 1906, when Theodore Roosevelt borrowed a metaphor from Pilgrim's Progress to warn against unbalanced reporting, he coined the name for a journalistic tradition. The most tenacious investigative reporters of that day became known as the "muckrakers," after Bunyan's description of "the man with the muckrake."
Among the targets of these reporters, many were medical "businesses." The first was the patent medicine industry, which Samuel Hopkins Adams exposed in a series of magazine articles that helped to pass the Pure Food and Drug Act. More than 100 000 reprints of Adams' articles were distributed by the American Medical Association, which also began running its own exposés of nostrums and quacks in a regular column in JAMA, "The Propaganda for Reform." Another report in the muckraking tradition was Abraham Flexner's Bulletin Number Four, with its attack on proprietary medical schools. From the 1930s through the mid-1960s, a period when organized medicine's