Wolinsky, Howard & Brune, Tom. The Serpent on the Staff: The Unhealthy Politics of the American Medical Association. New York: Tarcher/Putnam, 1994.

Date: July 29, 1994.

This book outlines the history of the political efforts of the AMA and discusses the current relavence of the AMA to the medical community and medical legislation. The authors offer a relatively objective accounting of AMA policy and politics; however, they clearly write from a cinical and antagonistic position. They write that one of the primary "problems" with the AMA is that its leaders view health care as a service rather than a "right." Wolinsky and Brune are reporters who have attributed the AMA with pursuing self-interested objective, and in a typical investigative reporting style they descriptively narrate with negative and alarmist overtones.

Upon identifying the author's slant, the reader is free to learn of the changing activities and policies of the AMA since its founding in 1847. Some of the more interest topics discussed are the development of the AMA as a political machine for the represention of doctors in Washington, the AMA's struggles against health care reform, and the ownership of lab facilities by physicians and their practice of self-referrals to medicare patients. In one of the last chapters, the authors describe a political relationship between the AMA and the tobacco lobby in which the AMA casts doubt on the 1964 surgeon general's report regarding the health hazards of smoking in return for support from tobacco firms and congressmen in the AMA's struggle against health care reform. Some key figures and events are listed below.

Dr. James Sammons - executive vice-president of AMA until Feb 1990, resigned under scandal.

Dr. James Todd - executive vice-president of AMA from1990 through present.

Dr. Alan Nelson - president of AMA - 1990

Dr. Robert McAfee - AMA president - 1994

Dr. George Lundberg - JAMA editor - In 1991, claimed it was time for medical insurance reform.

Dr. John Ball - ACP (Amer. Col. of Phys.) exec. v-pres. 1992

Dr. Willis Maddney - ACP pres. 1992

Dr. Lonnie Bristow - AMA Chairman of Board of Trustees - 1993-4

Fred Wertheimer - pres of "Common Cause" - "PAC reform" organization

Dr. David Murray - Chairman of Board of Regents - ACS (Amer. Col. of Surgeons)

Dr. Russel Patterson - former chairman of the Council of Ethical & Judicial Affairs.

Representative Fortney Stark - D-CA - Chairman of Ways & Means Committee health panel.

Dr. Blasingame - AMA cheif executive - 1964

Joseph Califano - Secretary of Health under Carter.

Ronald Davis - AMA delagate - Univ. of Chicago medical student. Ralied some member within

AMA to support political opposition against tobacco.

Arnold Relman - former editor of New England Journal of Medicine. Opposed self-referrals.

1994 - AMA founded.

1912 - House of Delegates bans "fee-splitting" among doctors.

1913 - American College of Surgeon founded.

1929 - House of Delegates prohibits commissions from colleague referrals.

1932 - Antitrusts suit brought against AMA.

1964 - Surgeon general's report on smoking hazards released.

- AMA (under Blasingame) opposes package health warnings and begins "further"

research.

- AMA eventually accused of supporting tobacco in exchange for support in

opposing Medicare.

1974 - A "campaign-reform" law was passed with the support of AMPAC.

- Comparatively advantageous to the Amer. Med. PAC; they could effectively

contribute above the limits via local organizations.

1976 - Carter submitted a hospital expenditure cap bill to congress.

- Oppose by AMPAC and defeated.

- AMPAC's opposition amounted to the largest dollar contribution to congress in

history to that point.

1985 - AMA opposed health liability suits against tobacco companies for quid-pro-quo

support on malpractice legislation.

1989 - Apr 28, Study released by Inspector General Richard Kusserow. Concluded 12%

of doctors billing Medicare owned an interest in the facilities to which they

referred patients.

1990 - Dr. James Sammons resigned as executive vice-pres. under scandal, replaced by

Dr. James Todd.

1991 - Dr. George Lundberg (JAMA editor) claims that the time have come for health

care reform due to too many uninsured citizens.

- Dec, Dr. Russel Patterson suggests that the AMA take an aggressive stance on

discouraging self-referrals and lab facility interests. He also assigned "cost

control" as a dominant concern for the medical profession.

1992 - AMA adopts a policy of compromise regarding reform in order to avoid a

Canadian system in the future.

- ACP, under Drs. John Ball and Willis Maddney, attributes health care with being a

fundamental right.

1993 - Jan, Rep. Stark introduces H.R.345 - a bill to ban all self-referrals. The AMA

doesn't oppose bill, but offers "better" solutions.

- Jul, AMA receives a grant to organize a $10 million tobacco control program.

- Dec, resolution adopted in House of Delegates supporting one of three options for

health reform: employer mandates, an individual purchase requirement, or some

combination of both. Conservatives in the AMA attempted to rescind the

resolution.

1994 - Feb, ASC, under Dr. David Murray, supports a single-payer (Canadian-style)

health plan.

J. Sprigg