The American Medical Association (AMA) faced an
identity crisis at its interim meeting in Dallas. What is the value of
its name? What does the name American Medical Association mean? What is
the AMA? Is it a moneymaking entity that lobbies for doctors? Or is it
a professional association that upholds the ethical standards that are
expected of its members?
A contract to endorse Sunbeam products brought the issues to a
head. In August, AMA top officials announced the so-called
"cobranding" or endorsement contract that would have put the AMA
name and logo on consumer medical products. There was no plan to
test the products, and it also violated an unwritten 40-year-old
rule against product endorsements by the group. The AMA Board of
Trustees hastily canceled the contract in September.
In the resulting furor, four top officials of the organization
resigned. A week before the AMA interim meeting in Dallas, the AMA's
top paid executive, P. John Seward, MD, also resigned after the New
Jersey delegation to the meeting introduced a resolution calling for
his ouster as well as that of AMA chairman Thomas Reardon, MD.
The AMA committee that heard the complaints of members about the
contract during the meeting convened beyond its planned adjournment
time as physician after physician lambasted the AMA board and executive
staff for selling the organization's name.
Arnold Relman, MD, former editor of the New England Journal of
Medicine, was the first speaker, in an unaccustomed appearance
before the body. "In my opinion, it is essential that this
association purge itself of all commercial deals that involve
endorsement of or joint marketing ventures with particular
health-related products and services sold to the public," he
said. "The recent trend toward the commercialization of the US health
care system and the growing threat of corporatized managed care to the
autonomy of doctors have made it increasingly difficult for physicians
to follow this fundamental precept" that their financial interests
should not influence their professional obligations to patients.
"Nevertheless, if they [doctors] do not, they will be
swallowed up by the healthcare corporations, and the process is already
happening," said Dr Relman. "Without an ethical compass, physicians
will end up as part of the labor force employed by or under contract
with these corporations or they will become profit-driven entrepreneurs
themselves, competing futilely with the corporations. In any case, the
relationship between physicians and patients will have been
fundamentally damaged. Equally important, a medical profession lacking
ethical standards that set it apart from business will inevitably lose
the public trust and the ability to influence public policy."
He exhorted the AMA to uphold ethical principles—standards it has
urged its members to follow. "The AMA's behavior itself and not
simply its rhetoric must reflect the values that it espouses for
physicians," said Dr Relman. "In short, the AMA is an association
of physicians, not a trade association, and its actions should reflect
that crucial distinction."
"I conclude by reminding you that the professional standing of
medicine is in greater jeopardy than at any time in the past
century," said Dr Relman. "I have been a physician for 51 years. We
are being judged now more than ever. More than ever, physicians need to
be represented by associations that promote professional
values over commercial interests. If the AMA wants to lead in this
effort, it must take forthright action against commercialism in its own
house."
He was followed by George Lundberg, MD, editor of the Journal of
the American Medical Association, who was clearly uncomfortable in
his role addressing the AMA House of Delegates. "But this is an
extraordinary time," he said. "Patients must trust their
physicians. Can they trust insurance companies, the managed care
companies, the increasingly for-profit hospitals and medical
institutions? No! Not really. The public needs to trust us and our
professionalism. Unfortunately, Sunbeam was not an isolated event.
Sunbeam was a cliff at the top of a mountain of commercialization,"
said Dr Lundberg.
Commercial ventures began, he said, when the AMA was threatened with
insolvency. Later, as the association became financially sound,
commercial ventures were used to support a host of activities. "In
commercial America, with Michael Jordan endorsing Nike and NBC
cobranding Notre Dame football, it wasn't such a leap for the AMA to
endorse Sunbeam," he said. But with that contract, the AMA suddenly
went over the cliff and crashed on August 12, 1997, said Dr
Lundberg.
"Five hard-working staff members departed. Others are confused,
demoralized, and looking for leadership," he said. "We are a
professional association. We are not Wal-Mart."
He and Dr Relman urged the group to pass measures that would put on the
written record the promise that the AMA would not endorse or
cobrand commercial products. The AMA's House of Delegates agreed,
passing a measure that expressly banned such commercial endorsement
when the AMA had no hand in the development or production of
the product. The limitation was introduced to allow the
organization to continue to publish and market its considerable library
of publications.
But frequent pleas that an outside investigation into the actions
that led up to signing of the Sunbeam contract went unanswered.
Reardon, chairman of the AMA board, said neither he nor other trustees
knew of the contract until the August 12 press conference announcing
its signing. Many delegates said they wanted to know how that could
happen.
The House, by a six-vote margin, approved an internal investigation led
by House members, who were appointed right after the vote was taken.
The other option was an investigation with an outside counsel. But much
of the story behind Sunbeam remains shrouded behind legal opinion.
Apparently, someone has laid out a plausible scenario for the
activities that led up to the contract, but AMA counsel refused to
release the explanation to the public. At least 200 members of the
House of Delegates reviewed documents that had been assembled by the
AMA's lawyers.
Delegates themselves were in two camps. One group wanted an extensive
investigation with outside attorneys. Others pronounced themselves
happy with the investigation already conducted by AMA lawyers and
requested "closure" so the group could move on.
But it will be some time before closure comes to the embattled
group. Although the AMA's Board of Trustees canceled the Sunbeam
contract quickly in September, the corporation immediately followed
with a $20 million lawsuit. Legal negotiations promise to keep the
issue alive for months, if not years.
© 1998 American Heart Association, Inc.
Cardiovascular News
Report on the American Medical Association Meeting
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