Skeletons in the Medical Closet

By

JCS

The AMA is a nonprofit agency whose mission is “to be an essential part of the professional life of every physician and an essential force for progress in improving the nation’s health,” according to the AMA’s website.  To most Americans, the concept of “nonprofit” goes hand-in-hand with trust, especially when it comes to “improving the nation’s health.”  That has been the smokescreen used by the AMA since Morris Fishbein first sold the AMA’s Seal of Approval, and it continues to this day.

At the same time in the 1940s when Fishbein and the AMA were demonizing any and all efforts to change the nature of healthcare, it was up to its neck in spurious money-making efforts, like placing tobacco ads in its journals. Indeed, if the AMA pretends to be the “guardians of health,” why did the AMA gladly accept huge fees from tobacco companies who advertised heavily throughout the twentieth century in its flagship journal, JAMA?

Advertisements in JAMA from drug and tobacco companies made the AMA and Fishbein exceedingly rich.  Under his reign, the tobacco companies became the largest advertiser in JAMA and in various local medical society publications.  It became obvious that Fishbein was not interested in health as much as he was interested in dominating the healthcare marketplace for profit.

Fishbein was instrumental in helping tobacco companies conduct acceptable “scientific” testing to substantiate their claims.  Some of the ad claims that Fishbein approved for inclusion in JAMA were:

• “Not a cough in a carload” (Old Gold cigarettes).
• “Not one single case of throat irritation due to smoking Camels”.
• “More doctors smoke Camels than any other cigarette.”
• “Just what the doctor ordered” (L&M cigarettes).
• “For digestion’s sake, smoke Camels” (because the magical Camel cigarettes would “stimulate the flow of digestive fluids”).

By 1949 when Fishbein was ousted, the AMA’s advertising revenue exceeded $9 million annually, thanks mostly to the tobacco and drug companies.  After Fishbein was unceremoniously removed by the AMA, his role was quickly taken over by others in the AMA who continued attempting to put a stranglehold on chiropractic.  The AMA may have changed leadership and its tactics, but it kept Fishbein’s strategy to eliminate the chiropractic profession.

Shortly after Fishbein left the AMA in 1949, he became a highly paid consultant to one of the large tobacco companies.  Under new editorship, JAMA published research results for the first time about the harm of tobacco.  Medical student Ernst Wynder and surgeon Evarts Graham of Washington University in St.  Louis found that 96.5 percent of lung cancer patients in their hospitals had been smokers.[1]

Although Fishbein’s legacy in the first half of the twentieth century is tainted with corruption and his misuse of the AMA finally led to his ouster, surely the AMA had learned from his mistakes, but it had not.  Not only did his anti-chiropractic campaign continue under the new AMA leadership, so did its quid pro quo policy with advertisers, as we see even today with the massive drug ads in JAMA and other medical publications.

Rarely has the AMA been embarrassed more than when the public learned of the AMA’s investments in the tobacco industry, but revelations of more conflicts of interest occurred again with the Sunbeam Corporation deal that shook the AMA to its very core in 1997.  The AMA agreed to endorse a line of products in return for potentially millions of dollars.  The products made by Sunbeam included blood-pressure monitors, heating pads, thermometers, humidifiers, and vaporizers.[2]

Due to declining membership and revenues, AMA executives agreed to endorse Sunbeam products for five years; that would have increased their treasury by millions.  And for Sunbeam, it promised to be better than Good Housekeeping to have the AMA’s Seal of Approval.

The public was outraged and editorial comments in American newspapers were forceful and led to the resignation of Dr. P. John Seward, AMA’s chief executive, preceded by the resignation of the association’s general counsel, chief operating officer, and vice presidents for business management, and marketing.[3]

In 1998, the AMA paid Sunbeam Corporation $9.9 million to avoid a breach-of-contract trial with the company after pulling out of the five-year, multi-million-dollar endorsement deal.  The AMA would have made millions of dollars in royalties by endorsing Sunbeam’s blood pressure monitors, humidifiers, and other products, but they backed out of the deal after being criticized because it had no plans to test the products.  The AMA entered into a deal to endorse products without testing beforehand, simply for profit.  The AMA only pulled out once the public got wind of the deal.

 “We did make errors of judgment and errors of process, and on top of that we got a second opinion, a rousing second opinion, from the American people,” said AMA spokesman Lew Crampton.[4]

Critics said the arrangement with Sunbeam could erode confidence in the nation’s highest-profile medical association.  “I think it is very treacherous for nonprofit groups in general, and health organizations in particular, to sell their names to corporations,” said Michael Jacobson, executive director of the Center for Science in the Public Interest, a consumer advocacy group.[5]

“It immediately sets up a conflict of interest,’’ he added.  “In the future, how can the AMA evaluate any Sunbeam product and warn the public if they are defective?  Or what if they are good products but twice as expensive as those made by other companies?”  Indeed, product endorsement for profit definitely creates problems for an association supposedly geared to the public’s interest.

“I think we should be embarrassed about this,” said John C.  Nelson of Salt Lake City, a member of the AMA’s board of trustees.[6] Inexplicably, his shame was greater concerning the Sunbeam miscue than any offered by the AMA for the attempted extermination of the chiropractic profession.

After the settlement with Sunbeam, the AMA said it was “now fully focused on its historic mission to serve America’s patients and the quality of American medicine.” [7]

Looking at the history of the AMA, it is unconvincing to believe the AMA’s goal has been to serve patients rather than to serve the interests of the AMA and its members. As authors Wolinsky and Brune mentioned in their book, The Serpent on the Staff, Americans had best awake to realize the AMA is not an altruistic medical organization dedicated to the betterment of patients; in fact, it is a virtual monopoly that should be branded as “AMA Inc.”[8]  Indeed, to “AMA, Inc.” money seems to be its real concern rather than the smokescreen of “guardians of patient care” or falsely accusing rivals of quackery.

After the Wilk trial, one might think the AMA had learned its lesson to stop with the lies, but apparently not. The chauvinism within organized medicine revealed itself on other occasions to illustrate the arrogance and greed of the AMA.

Not learning from its old mistakes, the AMA once again attacked an ancillary health profession—nursing! This attack wasn’t aimed at inferior patient care by nurses, but that nurses were cutting into the incomes of physicians.

While MDs get all the glory and most of the money in medicine, it is well known that nurses are the backbone of medicine doing the mainstay of patient care and operation of hospitals. Just as the US military would come to a halt without staff sergeants, so too would the medical profession be in chaos without nurses.

When the American Nurses Association (ANA) undertook in 1993 a key mission to expand the roles of their independent nurse practitioners, including nurse-midwives and nurse-anesthetists, the AMA felt threatened because nurses are less costly than physicians with average salaries of $45,000 vs. $111,800 for physicians at that time.[9]

Once again the AMA goon squad resorted to smear campaigns with offensive language to chide the concept that trained nurses might supplant physicians in some types of health care. Several state medical societies’ political action committees warned in fund-raising letters sent to doctors that some “daffy ducks” were trying to “fowl up”—one state said “duck up”—medical care by lowering standards and allowing unqualified people to practice medicine. The nurses said these physicians were accusing them of being “quacks.”[10]

The AMA believed giving nurses more autonomy “may increase the medical risk to patients and the ultimate cost of care.” Considering nurses care for patients, this insinuation was ridiculous. AMA leaders like to say that “nurses don’t know what they don’t know,” and that nurses “ought to go to medical school if they want to be doctors.”[11] I might add that doctors probably also don’t know what nurses know since they’ve never examined the nursing curriculum, just as the AMA never investigated the chiropractic curriculum before demeaning it.

The economic self-interest of physicians again blurred the AMA’s claims that it was looking out for patients. As ANA president Virginia Trotter Betts put it, “The issue is control, especially control of dollars. The AMA wants physician supervision because then the physician gets the first dollar.”[12]

She noted that the AMA “has also opposed autonomy for any practitioner, whether that be nurse, podiatrist, psychologist, social worker or chiropractor.”[13]

One might think after losing battles against chiropractors and nurses, and the embarrassment from its conflict of interest with tobacco and Sunbeam, that the medical association finally would have been knocked off its pedestal, but apparently the AMA has a short memory of these defeats. Once again the AMA asserted its supremacist attitude to reaffirm its top-cock position in the medical hierarchy.

In April of 2008, the American Medical Association House Of Delegates passed Resolution 232 to adopt that the title “Doctor,” in a medical setting, apply only to physicians licensed to practice medicine in all its branches, dentists and podiatrists.[14] This resolution would make it a felony for non-MDs to misrepresent one’s self as a “physician.”

Apparently rather than accepting that not all “doctors” are MDs, the AMA delegates acted to reclaim its lost luster by attempting to protect the titles “Doctor,” “Resident” and “Residency.” The delegates mentioned in the Resolution 232 that “The growing trend of this title encroachment is of concern because patients will be confused…”

Under federal statute, all doctors of chiropractic are considered physicians in Medicare and doctors of chiropractic are legally deemed chiropractic physicians in an overwhelming majority of states.

ACA President Glenn Manceaux, DC, said the resolution serves only to discount the education of non-MD health professionals and will stifle competition within the health care marketplace.

The members of our Association are deeply concerned about the AMA’s most recent attempt to undermine the legitimate education and training of doctors of chiropractic as well as other health care providers. It is not the role of organized medicine to regulate the titles and terminology used by other providers; it is the responsibility of federal and state legislators to bestow the title of ‘physician.’  As a trade association, the AMA is clearly overstepping its bounds.[15]

What’s most confusing is the audacity of the AMA to think it has exclusive use of the title Doctor, and more confusing is their acceptance of dentists and podiatrists as doctors too. Most people refer to dentists as dentists, not doctors of dentistry, and even more people have no idea what a podiatrist is. I doubt people are confused by these terms, but the AMA again asserts its monopolistic attitude by excluding chiropractors, psychologists, pharmacists, as well as doctors of nursing (DNP) and physical therapy (DPT).

Another example of medical prejudice occurred recently in 2008 when the AMA passed a resolution that announced a formal apology for its historical racism toward African-American medical doctors.[16] Recall that black MDs weren’t allowed to join loca medical societies or the national AMA, it was admirable that the AMA would confess to such professional racism. However, while black MDs were forced to sit in the back of the medical bus, lest we forget, chiropractors were thrown under the same bus.

When the AMA issued a public apology to its black members for years of discrimination, it was an excellent time also to issue an apology to the chiropractic profession for its illegal persecution.  Alas, no such contrition was forthcoming from the medical profession as if the prejudice against chiropractic never existed, chiropractors were never jailed on spurious charges, and the antitrust trial never happened.  Indeed, there are many skeletons that remain hidden in the medical closet far from the public view.

While the AMA is willing to apologize to its black members who suffered from prejudice and discrimination, to apologize for its documented campaign against chiropractors is apparently asking too much, thus illustrating the demagoguery and prejudice that still exist within the medical profession.

After the tobacco ruse and Sunbeam embarrassment, one would think the AMA had learned that conflicts of interest are inappropriate, but apparently not. In October, 2009, the American Academy of Family Physicians (AAFP) struck a deal with Coca-Cola to accept several hundred thousand dollars a year to sponsor its consumer-focused website. Coca-Cola will underwrite the development of “consumer education content on beverages and sweeteners,” according to the AAFP.

Considering the unhealthy aspects of soft drinks and sweeteners like high fructose corn syrup that have been implicated in our obesity epidemic and behavioral problems in children, for the AAFP to align itself with Coca Cola, undoubtedly the largest purveyor of junk sodas, this once again appears foolhardy.

Dr. Lori Heim, president-elect of the AAFP, makes no apologies for the association’s partnership with Coca-Cola.

We [the AAFP] know that we share common goals.” In this particular case, she notes, the goal is “to talk about sweetened and unsweetened beverages, and how you integrate that into a healthy, active lifestyle.

The AAFP recognizes the significant influence that consumer companies have on consumer health. We look forward to working with The Coca-Cola Company, and other companies in the future, on the development of educational materials to teach consumers how to make the right choices and incorporate the products they love into a balanced diet and a healthy lifestyle.[17]

It’s difficult to understand that a health professional believes these junk sodas have any place in a “balanced diet and a healthy lifestyle,” but for the amount of money at stake, she will find a way to rationalize endorsing Coke, just as Fishbein found a way to endorse tobacco products in his journal.

The bottom line is that political medicine has little concern for patient welfare as much as it has total concern for doctors’ financial welfare. If it were up to the AMA, there would be no other complementary or alternative practitioners, nurses would remain cheap labor for MDs, and patient treatments would be limited only to drugs, shots, and surgery.

Like any monopoly, the AMA can give a poor service at a high price, but without competition, the public has little choice. And as the 4^th branch of government with a strong hold on the media as a cultural authority, it remains the loudest voice in healthcare today.

As you will learn in subsequent chapters, this is the basic problem with the healthcare reform dilemma facing Americans. It is not that we don’t have enough medical doctors, but the real problem is that America has been handcuffed to limited treatments by practitioners with a myopia toward other treatments. The sad fact is the AMA has been the only voice for too long.

Indeed, if all it takes to have a healthy nation of citizens is more drugs, shots, and surgery, then no one should ever be sick in America. But they are, and only getting sicker because allopathic care alone is not the answer to this healthcare dilemma as you will learn.

For nearly a century the medical profession has had an iron-handed control of healthcare and the net results are shocking, expensive, and the source of many problems, which explains why we have a healthcare crisis today. Without a doubt, it’s time to loosen this grip and to stop throwing good money in after bad.