American Medical Association

The American Medical Association (AMA) founded 1847, incorporated 1897^[1] is the largest association of medical doctors and medical students in the United States. The AMA's mission is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education. It also publishes the Journal of the American Medical Association (JAMA), which has the largest circulation of any weekly medical journal in the world,^[2] The AMA also publishes a list of Physician Specialty Codes which are a standard in the U.S. for identifying physician and practice specialties.

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History

• 1847, Nathan Smith Davis and others established the AMA at the Academy of Natural Sciences of Philadelphia, Pennsylvania. Davis wanted to "elevate the standard of medical education in the United States." It was considered "impractical, if not utopian" by some. The goals of the AMA were scientific advancement, standards for medical education, launching a program of medical ethics, and improved public health. However a major goal of the organization, unknown by many, was to eliminate the “snake oil salesmen.” Who at the time were taking away a large percentage of business from the “doctors.” 250 delegates from 28 states attended the founding meeting at the Academy of Natural Sciences of Philadelphia, Pennsylvania. Nathaniel Chapman was the first president of the AMA ^[3].
• 1847, Original code of Medical Ethics.[3]
• 1848, the AMA notes the dangers of secretive remedies and patent medicine.
• 1858, the AMA established the Committee on Ethics.
• 1864-1865, Davis was president of the AMA during the American Civil War.
• 1873, AMA Judicial Council is founded.
• 1883, AMA begins publishing the Journal of the American Medical Association, now commonly referred to as JAMA.
• 1884, AMA supports experimentation on animals.
• 1897, AMA is incorporated.
• 1898, AMA creates the Committee on Scientific Research to provide grants for medical research.
• 1899, AMA creates Committee on National Legislation to represent AMA's interests in US Government.
• 1902, AMA gets its first permanent headquarters in Chicago, Illinois.
• 1903, AMA publishes Principles of Medical Ethics.[4]
• 1904, AMA establishes the Council on Medical Education to raise educational requirements for physicians [5].
• 1905, AMA creates the Council on Pharmacy and Chemistry to set standards for drug manufacturing and advertising. The Council also fought against quack patent medicines.
• 1912, the Federation of State Medical Boards is created. It accepts the AMA's rating of medical schools as authoritative.
• 1927, AMA Council on Medical Education and Hospitals publishes first list of hospitals approved for residency training.
• 1935, Social Security Act is approved.
• 1937, the 1937 Marijuana Tax Act is passed, which the AMA opposed; the AMA proposed marijuana be added to the Harrison Narcotics Tax Act.
• 1943, AMA opens an office in Washington DC.
• 1948, AMA hires conservative PR firm Whitaker & Baxter to defeat government-run universal healthcare coverage, which threatened doctors' salaries and looked certain to pass. Spending $4,000,000 ($37.5 million in 2006 dollars), the AMA manages to make its "socialized medicine" coinage stick, making government-run health care sound like a sinister communist plot.
• 1950, AMA starts a medical student section, called the Student American Medical Association (SAMA), initially as a pipeline into organized medicine. SAMA broke away from the AMA in the 1960s to become the independent, student-run, AMSA, the American Medical Student Association.
• 1952, House of Delegates adopts a council report condemning fee splitting in health care.
• 1957, AMA changes Principles of Medical Ethics.[6]
• 1960, AMA states that a blood alcohol level of 0.1% should be accepted as evidence of alcohol intoxication.
• 1970, AMA encourages the Federal Aviation Administration to require all airlines to separate nonsmokers from smokers.
• 1974, AMA gives recommendations to insure adequate protection of individuals used in human medical experimentation.
• 1976, AMA creates Section on Medical Schools.
• 1980, AMA changes Principles of Medical Ethics second time, approved July 22. Physicians were permitted to advertise their charges, and to refer patients to chiropractors. [7]
• 1982, AMA urges each state medical society to support laws to raise the legal drinking age to 21.
• 1987, in Wilk v. American Medical Association, U. S. District Court Judge Susan Getzendanner found that the AMA violated § 1 of the Sherman Act, 15 U. S. C. § 1, by conducting an illegal boycott in restraint of trade directed at chiropractors (895 F.2d 352)
• 1988, AMA creates the Office of HIV/AIDS.
• 1995, AMA starts campaign for liability reform.
• 1999, AMA creates Physicians for Responsible Negotiations (PRN, a labor organization to represent doctors, allowing them to advocate on behalf of their patients.
• 2000, AMA supports Patients' Bill of Rights legislation in Congress.
• 2001, Shortly after Sept. 11th disaster, the AMA provides the government with a list of 3,500 volunteer doctors who were ready to help. The AMA educated U.S. patients and doctors about bioterrorism and disaster preparedness through public service announcements, and by posting updated information on its Web site.
• 2001, AMA changes Principles of Medical Ethics third time.[8]
• 2005 AMA president Edward Hill, MD becomes the first AMA president to address the Gay and Lesbian Medical Association saying "I know that GLMA members and have been treated unfairly by the AMA in the past. There is simply no excuse for discriminatory actions or exclusions based on sexual orientation or -- none."^[4]
• 2006, AMA introduces the Physician Data Restriction Program designed to provide physicians with the ability to "opt out" of having their prescribing data released to pharmacuetical representatives for marketing purposes. Program also provides physicians with a mechanism to lodge compliants against pharmauetical representatives who act in an unethical manner. http://www.ama-assn.org/ama1/pub/upload/mm/432/pdrp_brochure.pdf
• 2007, AMA launches Therapeutic Insights, a quarterly Continuing Medical Education (CME) e-newsletter. Addressing one major disease state per quarter, each e-newsletter presents a succinct clinical overview by experts on the selected disease state and treatment practices, integrated best practices and evidence-based guidelines, disease state demographic information, and current national and state level evidence-based pharmacotherapy dispensing data for each condition. http://www.ama-assn.org/ama1/pub/upload/mm/432/insights_brochure.pdf
• 2007, AMA introduces JAMA-français. JAMA-français is the online French-language edition of the Journal of the American Medical Association. While print editions of JAMA are published in over 20 languages, this is the first non-English edition to be published online. This online French edition will be published weekly, coinciding with the release of the English-language JAMA. JAMA-français will feature selected articles from JAMA, including the leading article, Patient Page, and Clinician's Corner. Additionally, French-speaking physicians will be challenged with JAMA's CME quiz. JAMA-français en ligne: [9]
• June 2007, AMA amends its nondiscrimination policies to include transgender persons.

Charitable activities

• The AMA Foundation provides approximately $1,000,000 annually in tuition assistance to financially constrained students (who now graduate medical school with an average debt load of well over $100,000 each).
• Funds awareness projects about health literacy.
• Supports research funding for students and fellows around the U.S.
• Provides grants to community projects designed to encourage healthy lifestyles (of diet and exercise, good sleep habits, etc.)
• The Worldscopes program has a goal of providing over 100,000 stethoscopes to third world countries, donated by physicians and students.

Political positions

• For much of the twentieth century, the AMA opposed publicly-funded health care. When the 1937 Marijuana Tax Act was passed in the U.S., the AMA supported a federal law, but recommended cannabis to be added to the Harrison Narcotic Act.
• In the 1930s, the AMA attempted to prohibit its members from working for the primitive health maintenance organizations that sprung up during the Great Depression. The AMA's subsequent conviction for violating the Sherman Antitrust Act was affirmed by the U.S. Supreme Court. American Medical Ass'n. v. United States, 317 U.S. 519 (1943).
• The AMA's vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan. Since the enactment of Medicare, the AMA stated that it "continues to oppose attempts to cut Medicare funding or shift increased costs to beneficiaries at the expense of the quality or accessibility of care" and "strongly supports subsidization of prescription drugs for Medicare patients based on means testing". The AMA also campaigns to raise Medicare payments to physicians, arguing that increases will protect seniors' access to health care. In the 1990s, it was part of the coalition that defeated the health care reform proposed by President Bill Clinton.
• The AMA has given high priority to supporting changes in medical malpractice law to limit damage awards, which, it contends, makes it difficult for patients to find appropriate medical care. In many states, high risk specialists have moved to other states with such limits. For example, in 2004, not a single neurosurgeon remained in the entire southern half of Illinois. The main legislative emphasis in multiple states has been to effect caps on the amount that patients can receive for pain and suffering. These costs for pain and suffering are only those that exceed the actual costs of healthcare and lost income. Multiple states found that limiting pain and suffering costs has actually dramatically slowed increases in the cost of medical malpractice insurance. Texas, having recently enacted such reforms, reported that all major malpractice insurers in 2005 were able to offer either no increase or a decrease in premiums to physicians. At the same time however, states without caps also experienced similar results; this suggests the cyclical nature of insurance markets may have actually been responsible. Some economic studies have found that caps have historically had a dubious effect on premium rates.^[5] Nevertheless, the AMA believes the caps may alleviate what is often perceived as an excessively litigious environment for many doctors.
• Another top priority of the AMA is to lobby for change to the federal tax codes to allow the current health insurance system (based on employment) to be purchased by individuals. Such changes could possibly allow millions of currently uninsured Americans to be able to afford insurance through a series of refundable tax credits based on income (for example, the lower your income, the greater your credit).
• The AMA has made efforts to respond to health care disparities.
  • As such the AMA created an Advisory committees to assess the nature of disparities within different racial and ethnic groups^[6]. One such committee focuses on the health of the Gay, Lesbian Bisexual and Transgender community. In 2005, the AMA president Edward Hill, MD gave a keynote address to the Gay and Lesbian Medical Association at its annual conference.^[7] Since that time, the AMA has worked closely with GLMA to develop AMA policy towards better health care access for LGBT patients and better working environments for LGBT physicians and medical students^[8].
  • The AMA responded to the government estimate that more than 35 million Americans live in underserved areas by stating it would take 16,000 doctors to immediately fill that need, and the gap is expected to widen due to rising population and aging work force. "And that will mostly be felt in rural America," said Sen. Kent Conrad, D-N.D., adding, "We're facing a real crisis." Fueling the shortage crisis are the restrictions on allowing foreign physicians to work in the U.S. post the September 11, 2001 attack, and may become more restrictive after the attempted terrorist bombings June 2007 in Britain, still under investigation, linked to foreign[10][11]doctors.^[9][10]
• In June 2007, at its annual meeting, the AMA, discussed its opposition to a fast-spreading nationwide trend for medical clinics to open up in supermarkets and drugstores. The AMA identified at least two problems with in-store clinics: potential conflict of interest, and potential jeopardized quality of care. The AMA went on to rally state and federal agencies to investigate the relationship between the operating clinics and the pharmacy chains to decide if this practice should be prohibited or regulated. Dr. Peter Carmel, neurosurgeon and AMA board member asked, "If you own both sides of the operation, shouldn't people look at that?" The AMA also noted some employers reduce or waive the copayment if an employee goes to the retail clinic instead of the doctor's office, inferring that this practice might negatively effect quality of care.^[11]
• The AMA has affirmed, through continual policy statement (policies H-460.957,H-460.974,H-460.964,H-460.991, and resolution 506-2007 for example), its support for appropriate and compassionate use of animals in biomedical research programs, and its opposition to the actions of other groups that impede such research, such as some actions from animal rights groups, and its opposition to legislation that unduly restricts such research.

Criticisms

Critics of the American Medical Association, including economist Milton Friedman, have asserted that the organization acts as a government-sanctioned guild and has attempted to increase physicians' wages and fees limit by influencing limitations on the supply of physicians and non-physician competition. Friedman said, "The AMA has engaged in extensive litigation charging chiropractors and osteopaths with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible."^[12][13]. Critics who call the AMA a guild assert that these supply limiting actions not only have inflated the cost of healthcare in the United States but also have caused a decline in the quality of healthcare.^[13]

Profession and monopoly, a book published in 1975 is critical of the AMA for limiting the supply of physicians and inflating the cost of medical care in the United States. The book claims that physician supply is kept low by the AMA to insure high pay for practicing physicians. It states that in the United States the number, curriculum, and size of medical schools are restricted by state licensing boards controlled by representatives of state medical societies associated with the AMA. The book is also critical of the ethical rules adopted by the AMA which restrict advertisement and other types of competition between professionals, it points out that advertising and bargaining can result in expulsion from the AMA and legal revocation of licenses. The book also states that before 1912 the AMA included uniform fees for specific medical procedures in its official code of ethics. The AMA's influence on hospital regulation was also criticized in the book.^[14]

The AMA is also criticized because it derives a significant portion of its income by selling physician prescribing data to pharmaceutical companies.^[15] It continues to do this despite physician outcry, claiming approximately 33 million in revenue in 2005 from this practice. However, the AMA does allow physicians to "opt-out" of having their information shared through the Physician Data Restriction Program (PDRP).

Physician membership in the group has decreased to lower than 19% of practicing physicians. In 2004, AMA reported membership totals of 244,569, which included retired and practicing physicians along with medical students, residents, and fellows. The medical school section (MSS) reported totals of 48,868 members, while the resident and fellow section (RFS) reported 24,069 members. Combined they account for almost 30% of AMA members. [12] If every other member of the AMA was a fully qualified practicing physician than the AMA would represent 19% of America's practicing physicians (There are currently approximately 900,000 practicing physicians in America). However, MedPage Today estimates that the AMA only represents 135,300 "real, practicing physicians" as of 2005 (15.0% of the United States practicing physicians). [13] When asked about this, Jeremy Lazarus, MD, a speaker in the AMA House of Delegates, stated that membership was stable, avoiding commenting on the low overall numbers (2005 AMSA annual meeting, AMA vs. PNHP healthcare debate, Arlington, Va.).

See also

• AMA Scientific Achievement Award
• Office of Alcohol and Other Drug Abuse
• A Matter of Degree program
• American Osteopathic Association

References

• Friedman, Milton & Rose (1979). Free to Choose. New York: Harcourt Brace Jovanovich. ISBN 0-15-133481-1.
• Woods, Thomas E. Bring Back the Guild System? Ludwig von Mises Institute. [14]
• Jones, Henry (2005). How Medical Boards Nationalized Health Care. Ludwig von Mises Institute. [15]
• http://www.worldchiropracticalliance.org/tcj/1987/oct/oct1987a.htm

Further reading

• Burrow, James G. AMA: Voice of American Medicine. Baltimore: Johns Hopkins Press, 1963.
• Campion, Frank. The AMA and U.S. Health Policy Since 1940. Chicago: Chicago Review Press, 1984.
• Fishbein, Morris. History of the American Medical Association, 1847-1947. Philadelphia: W.B. Saunders, 1947.