Do You Know What the American Medical Association Really Is
Content
Do You Know What The American Medical Association Really Is?
August 25th, 2009
I am not a member of the AMA. My not being a member of the AMA is neither illegal, immoral, nor even questionable by any stretch of the imagination. I do not think a lot of people know what the American Medical Association really is. It is certainly not a legal agency of the American Government. It was founded, in 1847, by Nathan Smith Davis with the express policy of making medicine better. They do seem to administer a large amount of historical archives, including one called the Historical Health Fraud and Alternative Medicine Collection, even the title of which is a matter of grave concern to me, and indicates their our-way-isthe-way approach. It is usually taken for granted that they speak for all physicians in the United States. I remember when I first started calling myself a psychiatrist; it was only about 50% of physicians. Estimates in the last few years are that only 32% or so of physicians belong to the AMA, so I am not alone in saying this group does not speak for me. Some of this may be a result of the high cost of joining combined with what might be declining salaries of physicians. But the only physicians I have ever known personally who have not been members have elected not to join for the same reason I am not a member. I do not want to be a member of a political group that does not express what I think or feel about medicine. This feeling often extends down to loco regional medical associations. I was part of this association and loco regional associations before I really understood what is going on. I remember being told that it was good to be part of a historical association of my profession that would fight for better quality. I even remember being told, at some point in my career, that it would be a wonderful protection if I were ever sued for anything really, to show how “mainstream” I was. I even remember in one of the states in which I have practiced, being lectured to about and encouraged to be active in political action for medicine, which was most effectively done through membership in this august body. In this Midwestern state, judging by the talk within the audience of what I then considered my peers, none of us in the audience had the faintest chance of responding to this call; not because we had no interest, but rather because every single one of us was so busy seeing patients that we really did not have time to do anything outside of practice except tip over and fall asleep. But wait, there’s more.
It took me a while to figure out that the AMA (and its constituents) were political organizations, pure and simple. Let’s start with the above, where the AMA is “letting Congress know that it will oppose creation of a government-sponsored insurance plan.” Of course, they do not represent all doctors, have opposed changes to Medicare, lobby a lot, have money and power. “We are focused on health care that covers the uninsured,” sounds like “whoopsie, about face,” in a letter responding to the above article that is signed by the president of the AMA. Two weeks later. Look, I know they do represent more doctors than any other single group, but given the fact doctors are not usually focusing on being members of political groups, this is not really saying a lot. One of my absolute favorite things to do is to see how we are seen outside of our own country. Link above is to the reporting of the situation in a respected British source, the Manchester Guardian. Meanwhile, our friends at the AMA make no sense at all. They are now saying the new bill is only a “starting point,” and talking about things like universal medical records and, it seems to me, diverting the discussion from any kind of meaningful issue that could actually affect the lives of physicians. Everyone is dancing around the real problem. We spend more on health care and get less. The Manchester Guardian folks may be closest to the truth because they think internationally. I remember having a long chat with the dedicated director of an infant health care program in Los Angeles. She told me that a baby born in Los Angeles had a smaller chance of surviving than a baby born in Ethiopia. Couple that with the fact that the portion of the gross national product, the proportion of income, any way you count the expenditure on health care, we pay more for health care in America than anywhere in the world. The problem is a business that does not work. Anybody who has made it through any course on marketing, either at a public university or a private college, or the most elite course, has learned that if a business does not work, and this one does not, you fix the business. You gut its structure, remove things that bleed money. Of course, so many things are bleeding money that people cannot see where it comes from. Why doctors order too many tests. Why insurance premiums are so high. Why prescription drugs cost so much. I hate to be a naysayer, so I have really tried to figure things out. Most people make the decisions that govern their lives out of fear. I am not saying I have never been like this. I think most people, including me, get through medical school out
of fear of failing. We are endoctrinated, and no force, not pride nor dedication, is stronger than belief. For most of us, that belief is still rooted in fear. Doctors order extra tests to avoid malpractice, which can devastate a practice, a life, a family. There is no protection. Malpractice risk, law suits and their aftermath have caused devastated lives and even suicide. Right now, America is losing approximately 400 doctors a year–about the average size of a medical school class, to suicide, from this and other reasons. Most patient insurance premiums are so high because people fear losing profits. Insurance company executives with wealthy lifestyles are afraid of seeing their quality of life descend. People are afraid of seeing themselves go broke. Maybe they should be afraid, if their gains come from public manipulation, denial of claims, and the like. Same with the drug companies. I know that pharmaceuticals have done a lot in the past to improve life. I tip my hat to them for their help in the fight against tuberculosis. Does anybody besides me know that Whistler’s mother was only 44 when he painted her? We are living longer and older is looking better thanks to a lot of things, and pharmaceuticals are one. But every since the focus shifted, ever since someone discovered that people treated for tuberculosis got “happy” and the drugs that fought that disease became antidepressants, something went crazy. The lure of the pill that brings happy has seduced too many folks, both patients and corporations. Now I have seen estimates that over 85% of all pharmaceutical research is directed toward psychotropics. The patients I see are asking the same questions now that people asked about psychotropics when they were young. They are asking, “What is the worst thing that can happen” and “how is taking this stuff going to mess up my life?” As we progress, the cure seems not only worse than the disease, but worse than it ever was. We should not be surprised that some patients, those whose spirits have not been entirely crushed, seek alternatives. So the question is, “what system works?” and the answer is that the system works best when it works least. With a steadfast decision to ignore experiences in other countries, we have dived into a politics that is not only partisan, but also in bed with big business. Until that liaison between government and the big businesses of insurance and pharmaceuticals is dissolved, or at least weakened, health care will not work. Surely we are not crazy enough to expect people making tons of profits to voluntarily cut them back. Incidentally, this does not include physicians, who are not making tons of profit. The one I know are generally hanging on by their fingernails, can’t afford dues to a large professional association, and are hoping somebody somewhere will make sense of this. Countries who have pioneered socialized health care have already discovered its shortcomings. France, which is consistently mentioned as a superior country for health care, has a two tier system. Choose to be a private patient or a public one. It works pretty well, as I recall. Covers everyone. No doctors known to me (or to Michael Moore in “Sicko”) dying of hunger.
Once, in the late seventies or early eighties, a respected Indian colleague asked me if I wanted to go to India and work with his family practice. I answered in the negative, telling him I had some ties to the states and could not speak the language and frankly did not expect I would be accepted. He showed me a picture of what looked like a palace. He said his father, a respected physician in India, had not paid a penny for it. He said that as a Caucasian, I would be treated as a Brahmin. He was Brahmin (highest) caste of course, and told me everyone spoke English or in the rare cases I might want it, interpretation was easy. He said that I could stay with his family until I was known. It was not usual for money to change hands at all between doctor and patient; rather, if my patients got better and did well, the patients would make sure I lived well, and do things like build me a palace. If I were not a good doctor, this simply would not happen, but he thought me a good doctor, and said I would do fine. Now, for the first time in my life, I wonder if I was right in refusing him. I would have missed meeting my beloved husband had I gone. For that reason alone I am glad I did not. I have never been an angry person, but now I know not only indigent patients but insured patients are expected to die from lack of appropriate care, and given what I have done with my life so far, and what I believe, my anger is great. I feel like a passenger on a runaway train, with this combination of moneyed interests and partisan politics driving us into a ravine. The combination of increased cost and decreased efficiency in health care is deadly. It will take courage, courage which I do not believe anyone has expressed, to put the breaks on. Any and every solution I can suggest is the voice of a sliver of minority. There are a couple of ideas floating around that may be of use. While I do not think the judicial system has done much to help medicine so far, at least a few people have realized how much medicine and patients have been hurt by it. America has a precedent of “specialized courts,” where judges are especially trained. The idea of medical courts, impartial experts, trying to help both doctors and patients, and getting more money to patients instead of the 50% of all money made by litigation, are all good things. If a system like that did nothing else, it could make decent, hardworking doctors (I know this is not everyone) fear less and practice more. I think if we resurrected the ideals of the Founding Fathers, Thomas Jefferson in particular, we would come up with something like Free Market Medicine, which is already working in a variety of contexts, including my practice, and could work more globally with some effort and development. It takes guts, and limiting if not eliminating the money sucking businesses that hover over the once pristine doctor patient relationship. If individuals only made money by creating true value for society, these problems would not exist.
August 25th, 2009
I am not a member of the AMA. My not being a member of the AMA is neither illegal, immoral, nor even questionable by any stretch of the imagination. I do not think a lot of people know what the American Medical Association really is. It is certainly not a legal agency of the American Government. It was founded, in 1847, by Nathan Smith Davis with the express policy of making medicine better. They do seem to administer a large amount of historical archives, including one called the Historical Health Fraud and Alternative Medicine Collection, even the title of which is a matter of grave concern to me, and indicates their our-way-isthe-way approach. It is usually taken for granted that they speak for all physicians in the United States. I remember when I first started calling myself a psychiatrist; it was only about 50% of physicians. Estimates in the last few years are that only 32% or so of physicians belong to the AMA, so I am not alone in saying this group does not speak for me. Some of this may be a result of the high cost of joining combined with what might be declining salaries of physicians. But the only physicians I have ever known personally who have not been members have elected not to join for the same reason I am not a member. I do not want to be a member of a political group that does not express what I think or feel about medicine. This feeling often extends down to loco regional medical associations. I was part of this association and loco regional associations before I really understood what is going on. I remember being told that it was good to be part of a historical association of my profession that would fight for better quality. I even remember being told, at some point in my career, that it would be a wonderful protection if I were ever sued for anything really, to show how “mainstream” I was. I even remember in one of the states in which I have practiced, being lectured to about and encouraged to be active in political action for medicine, which was most effectively done through membership in this august body. In this Midwestern state, judging by the talk within the audience of what I then considered my peers, none of us in the audience had the faintest chance of responding to this call; not because we had no interest, but rather because every single one of us was so busy seeing patients that we really did not have time to do anything outside of practice except tip over and fall asleep. But wait, there’s more.
It took me a while to figure out that the AMA (and its constituents) were political organizations, pure and simple. Let’s start with the above, where the AMA is “letting Congress know that it will oppose creation of a government-sponsored insurance plan.” Of course, they do not represent all doctors, have opposed changes to Medicare, lobby a lot, have money and power. “We are focused on health care that covers the uninsured,” sounds like “whoopsie, about face,” in a letter responding to the above article that is signed by the president of the AMA. Two weeks later. Look, I know they do represent more doctors than any other single group, but given the fact doctors are not usually focusing on being members of political groups, this is not really saying a lot. One of my absolute favorite things to do is to see how we are seen outside of our own country. Link above is to the reporting of the situation in a respected British source, the Manchester Guardian. Meanwhile, our friends at the AMA make no sense at all. They are now saying the new bill is only a “starting point,” and talking about things like universal medical records and, it seems to me, diverting the discussion from any kind of meaningful issue that could actually affect the lives of physicians. Everyone is dancing around the real problem. We spend more on health care and get less. The Manchester Guardian folks may be closest to the truth because they think internationally. I remember having a long chat with the dedicated director of an infant health care program in Los Angeles. She told me that a baby born in Los Angeles had a smaller chance of surviving than a baby born in Ethiopia. Couple that with the fact that the portion of the gross national product, the proportion of income, any way you count the expenditure on health care, we pay more for health care in America than anywhere in the world. The problem is a business that does not work. Anybody who has made it through any course on marketing, either at a public university or a private college, or the most elite course, has learned that if a business does not work, and this one does not, you fix the business. You gut its structure, remove things that bleed money. Of course, so many things are bleeding money that people cannot see where it comes from. Why doctors order too many tests. Why insurance premiums are so high. Why prescription drugs cost so much. I hate to be a naysayer, so I have really tried to figure things out. Most people make the decisions that govern their lives out of fear. I am not saying I have never been like this. I think most people, including me, get through medical school out
of fear of failing. We are endoctrinated, and no force, not pride nor dedication, is stronger than belief. For most of us, that belief is still rooted in fear. Doctors order extra tests to avoid malpractice, which can devastate a practice, a life, a family. There is no protection. Malpractice risk, law suits and their aftermath have caused devastated lives and even suicide. Right now, America is losing approximately 400 doctors a year–about the average size of a medical school class, to suicide, from this and other reasons. Most patient insurance premiums are so high because people fear losing profits. Insurance company executives with wealthy lifestyles are afraid of seeing their quality of life descend. People are afraid of seeing themselves go broke. Maybe they should be afraid, if their gains come from public manipulation, denial of claims, and the like. Same with the drug companies. I know that pharmaceuticals have done a lot in the past to improve life. I tip my hat to them for their help in the fight against tuberculosis. Does anybody besides me know that Whistler’s mother was only 44 when he painted her? We are living longer and older is looking better thanks to a lot of things, and pharmaceuticals are one. But every since the focus shifted, ever since someone discovered that people treated for tuberculosis got “happy” and the drugs that fought that disease became antidepressants, something went crazy. The lure of the pill that brings happy has seduced too many folks, both patients and corporations. Now I have seen estimates that over 85% of all pharmaceutical research is directed toward psychotropics. The patients I see are asking the same questions now that people asked about psychotropics when they were young. They are asking, “What is the worst thing that can happen” and “how is taking this stuff going to mess up my life?” As we progress, the cure seems not only worse than the disease, but worse than it ever was. We should not be surprised that some patients, those whose spirits have not been entirely crushed, seek alternatives. So the question is, “what system works?” and the answer is that the system works best when it works least. With a steadfast decision to ignore experiences in other countries, we have dived into a politics that is not only partisan, but also in bed with big business. Until that liaison between government and the big businesses of insurance and pharmaceuticals is dissolved, or at least weakened, health care will not work. Surely we are not crazy enough to expect people making tons of profits to voluntarily cut them back. Incidentally, this does not include physicians, who are not making tons of profit. The one I know are generally hanging on by their fingernails, can’t afford dues to a large professional association, and are hoping somebody somewhere will make sense of this. Countries who have pioneered socialized health care have already discovered its shortcomings. France, which is consistently mentioned as a superior country for health care, has a two tier system. Choose to be a private patient or a public one. It works pretty well, as I recall. Covers everyone. No doctors known to me (or to Michael Moore in “Sicko”) dying of hunger.
Once, in the late seventies or early eighties, a respected Indian colleague asked me if I wanted to go to India and work with his family practice. I answered in the negative, telling him I had some ties to the states and could not speak the language and frankly did not expect I would be accepted. He showed me a picture of what looked like a palace. He said his father, a respected physician in India, had not paid a penny for it. He said that as a Caucasian, I would be treated as a Brahmin. He was Brahmin (highest) caste of course, and told me everyone spoke English or in the rare cases I might want it, interpretation was easy. He said that I could stay with his family until I was known. It was not usual for money to change hands at all between doctor and patient; rather, if my patients got better and did well, the patients would make sure I lived well, and do things like build me a palace. If I were not a good doctor, this simply would not happen, but he thought me a good doctor, and said I would do fine. Now, for the first time in my life, I wonder if I was right in refusing him. I would have missed meeting my beloved husband had I gone. For that reason alone I am glad I did not. I have never been an angry person, but now I know not only indigent patients but insured patients are expected to die from lack of appropriate care, and given what I have done with my life so far, and what I believe, my anger is great. I feel like a passenger on a runaway train, with this combination of moneyed interests and partisan politics driving us into a ravine. The combination of increased cost and decreased efficiency in health care is deadly. It will take courage, courage which I do not believe anyone has expressed, to put the breaks on. Any and every solution I can suggest is the voice of a sliver of minority. There are a couple of ideas floating around that may be of use. While I do not think the judicial system has done much to help medicine so far, at least a few people have realized how much medicine and patients have been hurt by it. America has a precedent of “specialized courts,” where judges are especially trained. The idea of medical courts, impartial experts, trying to help both doctors and patients, and getting more money to patients instead of the 50% of all money made by litigation, are all good things. If a system like that did nothing else, it could make decent, hardworking doctors (I know this is not everyone) fear less and practice more. I think if we resurrected the ideals of the Founding Fathers, Thomas Jefferson in particular, we would come up with something like Free Market Medicine, which is already working in a variety of contexts, including my practice, and could work more globally with some effort and development. It takes guts, and limiting if not eliminating the money sucking businesses that hover over the once pristine doctor patient relationship. If individuals only made money by creating true value for society, these problems would not exist.
