Chapter Twenty
HE WHO CALLS THE TUNE

AMA influence over the practice of medicine in America; how the leadership of the AMA keeps control away from its members; AMA funding by the drug industry; and examples of interlock between the two.

The American Medical Association climbed into bed with the Rockefeller and Carnegie interests in 1908 for the praiseworthy purpose of upgrading American medicine. Like the young lady who compromised her virtue "just this once" to pay for a needed operation for her ailing mother, the AMA has been sharing the sheets ever since.

The impact of this organization on the average physician is probably greater than even he recognizes. First of all, the medical student cannot obtain an M.D. degree except at a school that has been accredited by the AMA. He must serve an internship only at a hospital that meets AMA standards as a teaching institution. If he decides to become a specialist, his residency must conform to AMA requirements.

His license to practice is issued in accordance with state laws worked out by AMA leaders. To prove his standing as an ethical practitioner, he must apply to and be accepted by his county and state societies in conformity with AMA procedures.

AMA publications provide him with continuing education in the form of scientific articles, research findings, reviews and abstracts from medical books, question-and-answer discussions of clinical problems, evaluations of new drugs, foods, and appliances, authoritative essays, editorials, letters to the editor, and a hundred similar appeals to his intellectual understanding of the profession he practices.

At the AMA's week-long convention each year, the physician is exposed to what is called "a complete post-graduate education under one roof." If he has the interest and the stamina, he can attend his choice of hundreds of lectures, exhibits, and demonstrations; see medical videotapes; and carry home a suitcase full of pamphlets, books, and free drug samples.

As Richard Carter explained in his critical work entitled The Doctor Business:

On the national level, the AMA extended its authority far beyond the medical schools. As custodian of medical standards, it began determining the eligibility of hospitals to train new physicians. It gave authoritative advice on the training of nurses and technicians. It was influential in the passage of pure food and drug legislation, exposure of unscientific remedies, and stigmatization of cultism and quackery.(1)

1. Richard Carter, The Doctor Business, (New York: Doubleday & Co., 1958) pp. 78, 79.

The AMA spends millions of dollars per year for television programs to affect public opinion, maintains one of the richest and most active lobbies in Washington, spends many millions in support of favored political candidates, is instrumental in the selection of the Commissioner of the Food and Drug Administration, and ... well, let us just say that the AMA is a substantial force in American medicine.

Who controls the AMA? Most people would assume that the dues-paying members control their own association, but nothing could be further from the truth.

The AMA was founded in 1847 primarily through the efforts of three men:

• Dr. George Simmons

• Dr. J.N. McCormack

• Dr. Reed

Simmons was really the driving force behind the organization in those early days, acting as general manager, but McCormack and Reed shared in a great deal of the association's work including legislative lobbying.

Simmons is particularly interesting because he headed the AMA's drive against so called diploma mills, yet, it is said that he had obtained his own medical degree through the mail from the Rush Medical School.

One does not have to be a good physician to run a medical association. In fact, a man with a busy personal medical practice seldom becomes involved with the leadership of the AMA simply because he doesn't have the time to spare. Furthermore, the temperament that is required for success in the practice of medicine is not the same as that required for success in running a large membership organization.

For this reason, the AMA, from its inception, has been dominated by atypical physicians: men who enjoy the limelight and the thrill of accomplishment through medical politics. The typical physician, by comparison, is not only baffled by the intrigue and maneuvering for position behind the scenes, but wants no part of it for himself.

He is more than content to leave the affairs of his association in the hands of those who enjoy the game.

The deceptive appearance of democracy is preserved through the AMA House of Delegates, which meets two times a year. Reference committees are formed for the purpose of making recommendations on the various resolutions submitted by state delegates or by the National Board of Trustees.

But, following the pattern of political parties, the leadership maintains firm control over these resolutions by having the members of the reference committees appointed by the Speaker of the House, not by the delegates. The committees are stacked to carry out the will of the leadership. Those occasional innocents who are appointed for protective coloration usually are bewildered and overwhelmed.

One delegate who found himself lost in the maze complained:

It's difficult to make a sensible contribution to the work. If you're on a reference committee, all those resolutions are tossed in your lap and you can't make head or tail of the situation because you don't have time. The committee has not met before, has had no opportunity for advance study of the major issues, and is disbanded right after the convention, so the whole thing is kind of ephemeral.

Your problem is solved, though, because a member of the Board of Trustees is always present at the committee meeting to "clarify" the issues for you. In the old days it used to be even worse. Until a few years ago, none of the resolutions was presented in writing. You had to sit and listen to every word, and there were times when you found yourself voting for the exact opposite of what you thought you were voting for.(1)

1. Ibid., pp. 73,74.

The president of the AMA is a figurehead. He has no administrative or executive duties. His primary function is to deliver talks to various groups around the country explaining the program and goals of the Association. The position is honorary and is not part of the AMA's permanent leadership.

If any members or delegates should become dissatisfied with their leadership, there is practically no way for them to make a change. In order to do so would require a concerted campaign among the other delegates to support a whole new slate of executive officers. But even that remote possibility has been effectively blocked.

There is a standing rule, adopted in 1902, that reads,

The solicitation of votes for office is not in keeping with the dignity of the medical profession, nor in harmony with the spirit of this Association, and... shall be considered a disqualification for election to any office in the gift of this Association.

It is through tactics like these that the AMA perpetuates dictatorial control over its members while wearing the mask of democratic response to the will of the majority.

Not all physicians are blind to these facts. The AMA dictatorship was pointed out as long ago as 1922 in the December issue of the Illinois Medical Journal, the house organ of the Illinois Medical Society. In a scathing article entitled "The AMA Becomes An Autocracy," the journal charged that the AMA had become a dictatorship organization run by one man, that it had ignored the democratic will of the membership, that it concerned itself with building a financial empire to benefit those who control it, and that it does not serve the doctors who support it with their dues and reputations.

Since 1922 the state medical journals have become financially interlocked with the AMA Journal, so there no longer is any possibility of publishing such harsh views. But the discontent continues.

Doctors may not realize exactly who controls the AMA or why, but they increasingly are becoming aware that the organization does not represent them. By 1969, the AMA membership had stopped growing, and by 1970, it actually had declined. By 1971, less than half of all physicians in the United States were paying dues.

If AMA members or delegates do not control their organization, then who does? Who constitutes this "dictatorship" to which the Illinois Medical Journal has referred?

The structure and operating procedures of the AMA were well conceived to put total control of that organization into the hands of the one man who occupies the chief full-time staff position. Although supposedly hired by the AMA as its employee, actually he is beyond reach of the general membership because of his inside knowledge, his ability to devote unlimited time to the task, and his powerful influence in the selection of members of the self-perpetuating Board of Trustees.

But he holds even a mightier sword than that over the head of the organization because he also is the man who is responsible for bringing in the money The AMA could not survive on membership dues alone, and without the income secured by him, the Association would undoubtedly founder.

The key to financial solvency for the organization has been its monthly publication, the AMA Journal. It was begun in 1883 by Dr. Simmons as a last-ditch effort to save the infant association from bankruptcy. Its first press run was 3,500 copies and sold at a subscription rate of five dollars per year. But it was anticipated that the bulk of the revenue would be derived from advertisers.

By 1973, under the tight control of Managing Editor Dr. Morris Fishbein, it had a print run of almost 200,000 copies each month and had extended its publication list to include twelve separate journals including the layman's monthly, Today's Health.(1)

Altogether the AMA now derives over ten million dollars per year in advertising, which is almost half of the Association's total income.

Who advertises in the AMA Journal and related publications?

The lion's share is derived from the Pharmaceutical Manufacturer's Association whose members make up ninety-five percent of the American drug industry. Morris Fishbein became a lot more to the AMA than his title of Managing Editor would suggest. He was its chief executive and business manager. He brought in the money and he decided how it was spent.

His investments on behalf of the Association were extremely profitable, so the grateful membership could not, or at least dared not, complain too bitterly. One of the reasons for this investment success was that over ten-million dollars of the organization's retirement fund had been put into leading drug companies.(2)

1. This magazine has been particularly vicious in its attack against vitamin B17 cancer therapy. See "The Pain Exploiters; The Victimizing of Desperate Cancer Patients," Today's Health, Nov., 1973, p. 28.
2. "AMA Says It Owns $10 Million in Drug Shares," (UPI), News Chronicle (Calif.), June 27,1973, p. 4.

In later years, much of the executive control of the AMA was wielded by Joe Miller, the Assistant Executive Vice President.

Formerly an administrator of the government health program for Kentucky and an influential associate of the Lyndon Johnson-Bobby Baker group, Miller is viewed by many as a man who is devoid of political ideology, merely playing his role for whatever personal gain he can derive.

As such, he was a perfect choice for the pharmaceutical cartel with its extensive financial support of AMA programs. Either way, the success of the AMA and those who direct it depends on the prosperity and good will of the pharmaceutical industry.

Item: In 1972 the AMA's Council on Drugs completed an exhaustive study of most of the commonly available compounds then in general use. The long awaited evaluation hit like an unexpected bomb. The Council reported that some of the most profitable drugs on pharmacy shelves were "irrational" and that they could not be recommended.

And to add insult to injury, the chairman and vice-chairman of the Council stated before a Senate subcommittee that the large income derived from the various drug manufacturers had made the AMA "a captive arm and beholden to the pharmaceutical industry."

The AMA responded by abolishing its Council on Drugs. The reason given was "an economy move."(1)

Item: AMA spokesman, Dr. David B. Allman, clarified one of the prime directives of his organization when he said:

Both the medical profession and pharmacy must shoulder one major public relations objective: to tell the American people over and over that nearly all of today's drugs, especially the antibiotics, are bargains at any price.(2)

1. Crossing the Editor's Desk," National Health Federation Bulletin, Oct., 1973, p. 30.
2. Carter, op. cit., p. 141.

Item: While placating its member physicians with press releases and public gesturing against government intervention in the field of medicine, the AMA has been one of the most effective forces behind the scenes to bring about just the opposite. Under the beguiling excuse of "Let us defeat total socialized medicine by promoting partial socialized medicine," it has provided the model legislation for the nation's largest single step toward total government control ever taken in this area.

The legislation was known as Public Law 92-603, passed by Congress and signed by President Nixon on October 30, 1972. It was more commonly referred to as PSRO, which stands for Professional Standards Review Organization.

PSRO authorized the Department of Health, Education and Welfare to create a national and a series of regional boards for the purpose of "reviewing" the professional activities of all doctors in the United States. The men on these boards are to be doctors, but they will be selected or approved by the government and they must follow standards set down by government agencies.

These government boards are authorized to compel all doctors to standardize their procedures, treatments and prescriptions, to conform with those federal standards. All previously confidential patient records are to be available to the government for inspection. Doctors who do not comply can be suspended from practice.

This scheme was drafted by the AMA Legal Department, submitted to Congress as part of its "Medicredit" bill, and never approved by the AMA House of Delegates or its membership.

There are many more equally revealing items, but time and space call us back to our point of departure.

The foundations and the financial-industrial forces behind them have performed a great service in helping to elevate the American medical profession above the relatively low level of prestige and technical competence it endured in 1910. It is probable, however, that the profession, in time, would have done so by itself, and it is certain that it would have been far better off if it had. The price it has paid for listening to the siren call of money has been too high.

It has allowed itself to be lured onto the reef of a new medieval dogmatism in medicine - a dogmatism that forces all practitioners into a compliance with holy pronouncements of scientific truth - a dogmatism that has closed the door on the greatest scientific advance of the twentieth century.
 

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