Of the 1200 doctors in West Palm Beach, 47 endorsed the code. True to its word, the PMS published and distributed their names to its local members.

A Sophisticated Media Campaign. I asked Charlie how the PMS had chosen West Palm Beach. His answer made it clear that the organization is making very sophisticated use of the media.

"We were choosing among cities we could afford, those in the 60th to 70th largest media markets: cities like San Jose, Des Moines, Albuquerque, and West Palm Beach. We chose West Palm Beach for a number of reasons:

"The large number of Prevention readers. There were 13,000 subscribers in that one county alone.

"The major Miami media outlets right next door. We knew that spill over into Miami would give us hundreds of thousands of extra listeners and viewers.

"West Palm has enough connection with people from New York that the Eastern media accept it as part of the real world.

"We were testing a number of different pieces that made up the whole campaign: the code of practice, the community response, whether we'd get new members, our radio commercials, our TV spots, our newspaper ads, and our call-in talk show.

"The cost of the whole campaign came to about $75,000. For the same amount of money we could have done a mailing to every physician in the country or bought one spot on New York TV.

"Since the West Palm Beach action we've been evaluating the effect of each of those elements on the whole campaign. We're refining our plan of attack, tinkering with the model a bit. We'll be using the same general approach in other markets."

From the Top Down, Then Up Again. I asked Charlie if it wasn't a bit unusual for a consumer organization to be started by a well-funded national office instead of growing out of a coalition of local grassroots groups. He agreed that it was.

"What we're trying to do is begin from the top down, then to ignite local activity by providing information, ideas, and expertise for the use of autonomous local groups. We may call a meeting of all the PMS members in a certain area, but we're not planning to organize local chapters or anything like that. We just want to support whatever they come up with.

"The PMS plans to do three things: support local actions, act as a pro-consumer lobby on health policy, and provide information."

Supporting Local Actions. "We plan to develop models for several kinds of local actions. We'll teach local members and groups how to:

"Publicize key statistics on local providers—e.g. the rates of certain surgeries performed at various hospitals, death rates from certain operations, the rate and severity of doctor-caused illness in various facilities, and rates of malpractice clans.

"Identify and root out incompetent physicians."

"Promote the patient-oriented doctors in the community."

"Stimulate the establishment of laypeople's medical libraries modeled after the Planetree Health Resource Center in San Francisco."

"Analyze the health problems in the community and find ways to prevent them."

"Encourage prevention through bringing pressure on state and local health bodies, employers, unions, schools, and local media."

Hospital Evaluation Project. The PMS is now conducting a pilot hospital evaluation program in New York City. The organization has sent forms to more than 5000 physicians, nurses, and PMS members, asking them to evaluate the city's 78 hospitals.

The group plans to publish the results of those evaluations so that citizens can see how doctors, nurses and other consumers rate each facility.