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Monday, January 14, 2008

AMA President delcares war on "disease of social injustice"

The comments published by Dr. Ronald M. Davis, President of AMA, published in the AMA News were not the reason I opted not to continue my membership in AMA but they did reinforce my decision.

In a commentary (Jan 21,2007) he outlined the actions the AMA has taken regarding the "disease of social injustice". Dr. Davis is a specialist in preventive medicine. A review of the bio published by the AMA indicates he has spent his entire medical career in preventive medicine and I could find no reference to any clinical practice. ( I do not rule out there was some,but if, so it was not mentioned in the biography).

The preventive medicine vision is one in which it seems reasonable to support and believe in the concept of social justice where in one is concerned about equality of outcome as opposed to the quality of opportunity.There are endless opportunities to monitor for various inequalities and offer mitigating proposals. Job security written in capital letters. One expects to hear comments such as those by Dr. Davis in the publications of various public health organizations, in some of which Dr. Davis has been active. From the preventive medicine world we are used to hearing various issues characterized as disease. These strained metaphors of "disease-ifying" have including the diseases of spousal abuse, child abuse and illiteracy to name a few.

I believe the membership of the AMA to mainly consist of practicing clinical doctors rather than preventive medicine specialists.I am unsure what the role of a preventive medicine specialist is in leading such an organization or how appropriate is such a background to lead a group largely composed of physicians who actually practice medicine.

Dr. Davis outlines some of the AMA's accomplishments in this battle against social injustice including arranging seminars on the topic and urging the restriction of sodium in food products.

One of the most striking inequalities that practicing internists and family physicians might notice is that authored, encouraged and abetted by the AMA's RBRVS Committee (RVC) namely the delta between the CMS's compensation for the procedurists and the non-procedurists. An excellent review of that issue can be found here. I believe this to be a major factor in the worsening crisis in primary care.

Dr. Davis might do well to realize that as more and more docs opt out of primary care it will not be the more affluent population who suffers the most-although they ultimately will suffer too- and that the AMA has played a major role in that demise of primary care, seminars about inequality and campaigns to decrease dietary salt intake notwithstanding. I have made my views of the social justice issue clear before.Now I am suggesting that if Dr. Davis is concerned with improving health care for all -not just certain pre-defined demographic categories-he should focus some effort on correcting a major part of the problem caused by the AMA. If the ship sinks there should be little satisfaction in noticing the ultimate equality evident in that everyone is deprived a a life preserver.


Anonymous said...

Last figures that I read indicated only about 1/3 of doctors belong to AMA.With their track record regarding RUCs and profiting from selling drug companies our prescriptions history,I am surprised the number is that high.I think that there are many " higher ups" in the organization who are as out of touch with daily medical practice as is their current president.

Anonymous said...

James, you are correct. It may be of interest to you to know that the move from treatment to prevention happened in Germany shortly before Hitler came to power, including the actual words used.

Increasingly, health plans and government are calling on doctor's to inventory the habits and lifestyles of citizens under the guise of "public health." Even DNA and genetic predispositions are under study. Visit our http://www.itsmydna.org website, as one example.