Report on the American Medical Association Meeting
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.
- Copyright © 1998 by American Heart Association