Corporate Endorsement Another Blow to AMA Image

In return for its recent decision to endorse a line of heating pads, thermometers and other products made by the Sunbeam Corp., the American Medical Assn. is expected to gain millions of dollars in royalties. But no amount of money will be enough to restore what the organization has lost in reputation by agreeing to a deal fraught with conflicts of interest.

In promising Sunbeam that it will not endorse a rival’s products, for instance, the AMA has abrogated its right to steer consumers toward better products and compromised its ability to warn consumers about defective ones.

The AMA’s need for funds is partly driven by its steady decline in membership since 1991. Of the 17,000 doctors who become eligible to join each year, only 1,500 now do so. There is a perception, especially among younger physicians, that the AMA is the domain of older male physicians who oppose needed health care reforms. That perception is not far off the mark. The politically powerful AMA helped seal the defeat of President Clinton’s admittedly overdone attempts to create national health insurance in 1994 and generally has resisted changes in the status quo.

Meanwhile, the AMA has failed to embrace a strong leadership role in the modern health care era as an advocate for health care standards. The organization, for instance, mounted a late and tepid response to HMOs that let accountants rather than doctors dictate medical decisions and that fail to give doctors enough patient time to diagnose problems correctly.

The AMA has also been laggard in social reforms. African American doctors account for nearly 4% of American physicians but only about 1% of the AMA’s active members. This is largely because the association has failed to fully address the harm caused by its historical ban on black members, which persisted in some areas until 1968. And while the pay gap between male and female physicians is closing, the AMA is not lobbying vigorously enough to correct women’s continuing underrepresentation in academic medicine and medical management.

Earlier this summer, the AMA announced that Dr. Nancy Dickey will become its first female president. She has shown a willingness to frankly address the racism and sexism in the history of American medicine. But she will also need a plan for change, better than the foggy AMA pledge this month to encourage more financial and moral support for minorities.

If the AMA wants to protect its reputation, in the future it must do just the opposite of what it did with Sunbeam. By building an identity as an advocate for good medicine, the AMA could both prevent its obsolescence and serve the public interest as a knowledgeable balance to managed care.