I spent nearly 2 years with the AMA, an organization that should be vital to medicine but is too focused on leftist issues.
I spent nearly 2 years with the AMA, an organization that should be vital to medicine but is too focused on leftist issues.
The Rot of Our Institutions – Part III
What I Saw at the AMA
“The difference between successful people and really successful people is that really successful people say no to almost everything.”
Warren Buffett
I learned that we can do anything, but we can’t do everything... at least not at the same time.
Dan Millman
If you keep chasing the wrong things, the right things will never have a chance to catch you.
Robert Ricciardelli
During my podcasts, I often refer to events in my personal life. But I rarely mention names. I spent nearly two years with the American Medical Association, and I will provide thoughts based on some of the things I saw during my tenure. But I have some caveats. With one exception, I will mention no names nor provide anything that is not also corroborated by additional sources. This is not because I am afraid of some lawsuit. Lawyers do not intimidate me and I am a small fry in terms of the AMA. But it is not my style to reveal what was entrusted to me for secrecy, nor to put admired former colleagues in a cleft stick.
Nevertheless, what I saw at the AMA was of such a disappointing nature that I am compelled to share my thoughts about the organization. I have read much about the ACLU, Amnesty International, and essential institutions nationwide. The difference is that when working for the AMA, I lived the decisions every day and, in some fashion, was culpable for the organization’s errors.
The problem with today’s institutions is not that they are deficient in themselves; instead, they have been hijacked for purposes other than their missions. The American Civil Liberties Union or ACLU is a good example. This organization is dedicated to preserving free speech and the First Amendment. That is a great mission. Like any sane person, I would decry the Nazis, but I would not advocate for a permanent ban on their speech. It was the ACLU who, decades ago, took this very unpopular but righteous stand. After all it is the speech to which we strongly disagree that needs to be preserved or there is no real free speech.
That was then. Today’s ACLU: “The fundamental constitutional protections of due process and equal protection embodied in our Constitution and Bill of Rights apply to every person, regardless of immigration status.” They had me right up until the immigration status part. I should note that the A in ACLU does stand for American. The problem is the equation of our constitution, dedicated to the citizenry of the US, against that of all immigrants. Note that the ACLU does not distinguish between legal and illegal immigration. So, are there no distinctions between citizens and non-citizens? And this is on their front page, not a section of addendum to their mission.
The ACLU is also big on pro-Palestinian causes even though the Palestinian-elected Hamas is the antithesis of free speech advocacy. I always like how leftists blame Trump on Trump voters but never blame the Palestinians who elected Hamas.
But, like the Nazis, the ACLU is protecting free speech. So why at no point does the ACLU put in a front-page qualifier about the free speech of Jewish organizations whom elite universities have also silenced. Another example is Trans rights. But what are the rights of women to maintain an all-women team? Do they agree with Riley Gaines speech? In other words, the ACLU now picks sides, and those sides are always speech supporting leftist dogma.
The ACLU is supported by dues and more than $50 million in contributions annually from individuals and grants from foundations. One of the key contributors is the now-leftist Ford Foundation. Another was Peter Lewis, founder of Progressive, the insurance company of which Lewis aptly named.
One of the reasons that these organizations can operate on a radical agenda is the same as I noted in the last podcast. If one is not obligated to respond to specific pressures, including money, then one can act as one likes. Because the government now essentially funds universities, they can do as they please.
And I will now pivot to the AMA and tell you about something in which I was intimately involved. According to the organization’s annual report, in 2022, the American Medical Association generated about $493 million in revenue. Of that sum, less than $34 million came from membership dues. The largest revenue source was “royalties and credentialing products,” which amounted to over $293 million. And here is something you probably you have never heard before. Current Procedural Terminology or the CPT code set is something you have unknowingly encountered dozens of times in your healthcare.
The Current Procedural Terminology (CPT) code set is a standard used by healthcare to identify medical procedures. Hip replacement? There is a CPT code. Get a stent to unblock an artery? One for that. The administration of a vaccine? Another CPT code. These are not the same as drug codes but rather the procedure upon providing these drugs, but much more than that, they cover all medical procedures. There are over 10,000 CPT codes, with updates on many occurring throughout the year. The AMA owns the codes and licenses them to hospitals, insurance companies, and other healthcare entities wishing to use these codes. The hospital must submit to insurance if a doctor does a hip replacement. This becomes much easier using a code than the lengthy descriptor of the procedure.
And as I have noted, they make up over 80% of the revenues for the organization. Because of CPT, the AMA does not rely on member dues, grants from other associations, government funding, or revenue from ads or trade shows. They are highly lucrative, enabling the AMA to support, well, really, any position they fancy. And my old role was to promote the use and the value of this code set, among many other things.
There was another organization for which I worked. The Emergency Nurses Association derived over 20% of its revenue from obtaining and keeping members and another chunk from classes and emergency nursing trade show events. This had the effect of muting many of the more progressive voices in the ENA because to declare support for, let’s say, gender-affirming care might mean the loss of members due to the radical and unnecessary position on this issue.
My side of the AMA would make the money, and most of the rest of the organization would spend it. And as you saw from the numbers above, there was a lot to spend, including on advocacy. Logically, a medical association would be involved in advocacy, given that healthcare is a $4 trillion industry. Everyone, from hospitals to insurance companies to, most of all, the government, has a stake. I never had an issue with that part of the AMA, but rather, the question arose in my mind about whether the AMA was advocating for things in their mission, what they were purported to be about: “To promote the art and science of medicine and the betterment of public health.” That is an important, robust, and exciting mission. The problem is that this was merely a springboard for the current leaders of the AMA to go into many different areas. Here is an example provided by Kevin Williamson in 2022,
The efforts of the American Medical Association and similar organizations to medicalize the debate over gun control, part of a larger effort from progressives to pathologize dissent, is typical of the pattern. Doctors, like scientists, enjoy a great deal of prestige, much of it well-earned. That prestige is rooted in specialized expertise. But like the businessman-politician who argues that what’s needed is to run the IRS or OSHA as though it were a business, physicians mistakenly generalize their actual expertise and experience. It’s the same thing behind Michael Jordan’s baseball career: “I’m good at this, so I must be good at that.” And so a guy who belongs to a professional association in which other people treat patients for gunshot wounds comes to believe that he has special knowledge about the questions of regulation and constitutional jurisprudence related to gun control and that he has special moral and intellectual standing to speak on these questions.
In about as concise a judgment as possible, Williamson states, “The policy preference comes first, and the medicalized rationale comes after. And the policy is not the result of medical judgment but political judgment.”
And which policies?
AMA Board Member Michael Suk stated in a press release, “Gender-affirming care is medically necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people.” Someone explain to me how mutilation of the body, especially based on a possibly mistaken gender identification of a hormonal teenager, squares with the Hippocratic oath of do no harm?
In a clear blow to parental rights, another AMA resolution that passed in 2023 amended a preexisting policy to oppose mandatory reporting of information related to sexual orientation and any information related to gender transition, including for patients who are minors. This is a debatable topic, and my position is to be very deferential to parents before state functionaries, but how is this germane to the betterment of health?
We began with gun control, so here is the AMA’s stated position: “Gun violence is a plague on our nation. It’s a public health crisis, and much of it is preventable,” said then-AMA President Gerald E. Harmon, in remarks to the House of Delegates at the 2022 AMA Annual Meeting. “This cannot be our new normal. Gun violence is out of control. Enough is enough.”
As a rebuttal to the AMA going full tilt into Gun Control, Williamson adds, “If it were a matter of individual human lives being snuffed out, then the AMA might instead be focused on, say, abortion, which ends about 45 times as many American lives every year as people with guns do. Given that the violence of abortion is perpetrated very prominently by members of the AMA, the organization is uniquely positioned to do at least a little something about that. What happens in an abortion is as a medical question of less interest to the AMA than is abortion as a political question.” And on this topic, unsurprisingly, the AMA is full-on pro-choice, even issuing a press release decrying the overturning of Roe V Wade. During that particular day, I witnessed several colleagues disparaging the nation’s fate while I kept an understandable silence.
The questions of a medical debate vs. a legal, policy, or moral debate are at the heart of the AMA’s mission creep.
And here is an alarming bit that would make Thomas Malthus, the 18th-century decrier of population growth, proud. Reflecting the left’s unnatural hatred of humanity, the AMA went in for population control in a pretty big way, and it offered the familiar medicalized rationale: “The problems that related to human reproduction, including the need for population control, are more than a matter of responsible parenthood; they are a matter of responsible medical practice.”
I always like to note that when Malthus declaimed the end of humanity, the magic number for Armageddon was 1 billion. We now have eight times that number today, less hunger, and far more global prosperity than during Malthus’ time. The fact that a supposedly science-driven organization would make that statement is appalling.
And the AMA is all in, ridiculously, on climate change as if Drs. Thunberg and Gore were on the Board of Trustees. Here is there statement, “The policies adopted today build upon AMA’s existing policy and efforts to halt the global climate crisis. Most recently, in June, the AMA declared climate change a public health crisis and directed the AMA to develop a strategic plan for how to enact its climate change policies, including advocacy priorities and strategies to decarbonize physician practices and the health sector.”
When the AMA speaks about climate change, it does not speak about the actual medical questions related to climate change; instead, it engages in simple, ordinary political activism, for example endorsing changes in the electricity-generating industry as though the world’s physicians collectively knew the first thing about operating utilities.
And, of course, they call this a crisis, adding to the gun crisis, the population crisis, and, as we shall see, the equity crisis. If everything is a crisis? I can provide a series of countervailing arguments regarding climate change. Yet, in their climate change manifestos, there is nothing about nuclear, so we know they are not serious. I will repeat: if Climate Change is an existential crisis that will destroy us in the short term, the only short-term solution, not involving us going back to medieval times, is nuclear.
But note what is not being debated. Was the COVID-19 vaccine effective? How do we solve hypertension, diabetes, or cancer? Are Physician Assistants a worthy substitute for doctors? What about telehealth? As more doctors become employees than self-employed, what does this mean to healthcare? The AMA touches on these things, but the energy lies elsewhere.
Today’s AMA is no longer exclusively focused on medical issues but has been morphed into yet another vehicle to drive progressive public policy, albeit with the false patina of genuine, measurable healthcare improvement as its goal.
And now, I come to their vaunted Center of Health Equity or CHE, a part of the AMA. In 2019, the AMA adopted policy changes to recognize diversity, equity, and inclusion efforts as “a vital aspect of medical training” and directly oppose any government attempts to “limit diversity, equity, and inclusion initiatives, curriculum requirements, or funding in medical education.” That same year, the AMA announced a group dedicated exclusively to DEI, which would grow to over 60 people.
Part of the CHE mission was to drive AMA-adopted policies claiming racism as a public health crisis and calling for the elimination of race as a proxy for ancestry, genetics, and biology in medical education, research, and clinical practice. Then, in May 2021, the AMA issued its 86-page, far-left extremist Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity.
The AMA plan complains that the use of calculators and artificial intelligence is racist and demands “just representation of Black, Indigenous and Latinx people in medical school admissions, as well as medical school and hospital leadership, ranks,” and envisions “a nation in which . . . all physicians are equipped with the consciousness, tools, and resources to confront inequities and dismantle white supremacy, racism, and other forms of exclusion.” Just representation?
Kevin Spivak, writing for American Mind, noted the Strategic Plan,
As part of the American Medical Association’s (AMA) equity plan to increase diversity, equity, and inclusion (DEI), the powerful lobbying group is sponsoring 100 virtual screenings of Black Men in White Coats whose premise is that blacks will “continue dying” unless there are more black doctors. Black Men in White Coats is emblematic of how America’s oldest and most prestigious professional organization has adopted a radical agenda that places health care at risk by subordinating merit, individual empowerment, professional standards, and the Hippocratic Oath, including its core message of “first do no harm.”
And that strategic plan? Here is a sample
“It is common that discussions in the field of equity begin with the recognition that our current state was built on the land and labors of others in ways that violated the fundamental principles of equity. Another distinction of the equity field, which essentially is an extension of this land and labor acknowledgment, is to initiate a discussion with recognition of the specific harms of the past, including those of the more recent past (termed ‘truth and reconciliation’).”
Wait what? Land and labor? What in the name of Pete does native American land ownership have to do with treating multiple sclerosis? I should provide a brief primer here. For the uninitiated, when one reads a leftist talking of labor, think of Marxist ideology. And here is how the dots connect. In the 1950s, Marxists invented the concept of Critical Theory, which proposed that all power structures are based on class. In the 1980s, this was transformed by Derrick Bell and others into Critical Race Theory, which states that all systemic power is based on race. For one to see this in the academy, chock a block full of wild-eyed professors, is one thing. But to see that people who are supposed to help cure diabetes or cerebral palsy sound like academic Marxists is alarming.
And yet that is what CHE was fundamentally comprised of. There were over 60 people when I was there, and though the head of the unit was a physician, most of the staff were activists drawn from various academic and governmental roles and associations. Health experts, some. Experts in operational goals and outcomes? Not really. Experts in grievance and oppression narratives? Absolutely.
One of the items within the Strategic Plan was for doctors to refer not to slavery but to the now academically accepted term of “enslaved peoples.” And, of course, when discussing medical conditions with a physician, whether it be stomach pains, a bad knee, or inability to sleep, the subject of slavery would almost certainly come up, right?
The Strategic Plan was a classic example of a group wanting to discuss their issues, their narrative, their grievances, and not that of what should be the discussion between patients and doctors, the former’s health, and the latter’s prognosis and diagnosis. And the flush AMA could better accommodate the plan’s writers than the academy or some smaller association.
As the Wall Street Journal noted in 2022, “Aspiring doctors will have to learn that race is a “social construct that is a cause of health and health care inequities, not a risk factor for disease.” Yet racial or ethnic groups do sometimes have a greater propensity for certain health problems. For instance, black women are at higher risk for a type of breast cancer known as triple-negative, and certain women of Jewish heritage are at greater risk of the BRCA gene mutation.” Forget the dogma; even in science, CHE gets it wrong.
Here is another sample from the same document pounding the message of stolen land:
We acknowledge that we are all living off the taken ancestral lands of Indigenous peoples for thousands of years. We recognize the extraction of brilliance, energy, and life for labor forced upon people of African descent for more than 400 years. We celebrate the resilience and strength that all Indigenous people and descendants of Africa have shown in this country and worldwide. We carry our ancestors in us and are continually called to be better as we lead this work….We envision a nation in which…all physicians are equipped with the consciousness, tools, and resources to confront inequities and dismantle white supremacy, racism, and other forms of exclusion.
First off, 400 years. Even assuming the date of 1619, that is about 200 years because slavery ended in 1865.
We can debate Jim Crow, but this also notably excludes the last 70 years since the Civil Rights legislation. I may not be able to lecture a doctor about medical procedures, but I can sure as heck go toe to toe on the history statements.
And there is no room for dissension from this narrative.
Spivak adds.
“The AMA has ruthlessly suppressed any debate of its policies. For example, when Edward Livingston, then a deputy editor of the Journal of the American Medical Association, criticized the concept of structural racism in health care, the AMA terminated him, and AMA CEO James Madara released a vindictive public statement accusing Dr. Livingston of hosting a “harmful” podcast. Just weeks later, the Journal’s editor-in-chief also was forced out.”
The dismissal of the senior leadership of the once revered JAMA happened before my time.
But it was still talked about to the point where I was able to listen to the entirety of that exchange.
Livingston did not say that brown and black doctors could be ineffective. Instead, he was saying that he had not seen the systemic racism being claimed and that most doctors were not, in fact, racist and tangentially saying he was not a racist. Yet in an era of Ibram X Kendi, if you do not support the concept that systemic racism is rife in healthcare, if you ignore the extreme leftist narratives, you are, in fact, a racist, so the leaders of JAMA had to go.
It is frustrating on many levels. There is little valid scientific basis that more black doctors will solve black health issues as compared to improving the quality of any doctor or hospital who treats black patients. How a black doctor might better relate to pancreatic cancer, hypertension, or diabetes, which happens to infect a black patient, is nonsense. An excellent white doctor is better than a bad black one, AND vice versa, by the way. I am not certain Ben Carson made a great Housing and Urban Development Secretary, but if my children needed a pediatric brain surgeon, he would have been on the shortest of lists not because he is black but because he was acknowledged as being great at his job. And under-representation is a very poor metric. Asians constitute 5% of our total population, yet they represent 17% of physicians, whereas whites represent 56%. In this metric, 6% of doctors are black compared to a US population representing 13%.
Significant changes will be required in medical school admissions and healthcare employment to achieve the equity of outcome envisioned by the AMA. These changes will be painful for many, and the side effects will be even worse. The AMA is advocating an outcome-based quota system that would lead to lowering standards today. And, of course, when someone encounters a black doctor under these standards, they will unfairly question them. Thomas Sowell calls this the “soft bigotry of low expectations.”
But let’s say that as a societal good and as a physician-led, physician-driven, physician-member organization, the AMA wanted to take the lead here not in lowering standards but in raising the quality of black physicians. Very little of what CHE is doing will improve on that goal; instead of lowering standards, how about raising quality candidates?
What does the Center of Health Equity not do? There are no programs in the Junior or High School systems to teach brown and black students biology, thus preparing them for future medical careers. Setting up and implementing these programs would take focus, discipline, and years before any results could be discerned. And there is that issue, the results. CHE does not broker in results; they broker in oppression narratives and grievance.
Adding to a different approach, Spivak notes, “We must identify and address the deficiencies in K-12 education that are failing blacks and Hispanics. Skipping the hard work and ignoring reality re-victimizes minority students and society at large. Racism is an ugly direction in which to move America. Marxism has failed every place it has been tried, and always at the cost of great human harm. The politicization of one of the few institutions still respected by most Americans will prove no different.”
Amnesty International, once about freeing political prisoners, today features an anti-Israel message and a gun control message on its front page. The Rand Corporation, an advisory to the Pentagon, has gone in on DEI. “We’re committed to building and sustaining a culture that integrates DEI principles into our everyday operations and engagements.”
This is what we call scope creep.
But that is not really accurate. Instead, it is an invasion from within.
In the previous podcast, I noted how radical leftist baby boom students, instead of leaving the university, stayed and warped the purpose of the academy. Having the commanding power of the colleges through which millions of Americans passed, they were free to inflict their dogma. Their intellectual progeny figured that if they could do it in the academy, why not without? Many moved into these organizations and began to infect the thinking and mission of these institutions. The result has been the abandonment of the core mission, as we have seen with the AMA, to the detriment of the organizations, those they serve, and society as a whole. Who wins?
The mediocrities hiding behind these shibboleths.
Here is the problem. We need a non-governmental organization to advocate for healthcare. The nature of the government itself, or its healthcare administrator, the Health and Human Services, is by its nature, as a governmental body, focused on something other than the betterment of care. Where that happens, it is almost a happy accident. The current head of the HHS is Xavier Becerra, a far-left California radical who desires a single-payer system. As noted in Forbes during Becerra’s confirmation, “However, while Becerra has fought to protect the ACA, he has expressed that he wants to see a single-payer health care system—commonly called Medicare for All—established in the US. “For me, health care is a right,” he said. “I’ve been a single-payer advocate all my life.”
As it happened, I parted ways with the AMA this past summer on good terms. I had added value (as I have to every organization of which I have been a part), and in the unit to which I was assigned, I had respect for my colleagues’ dedication and hard work. They believed in the original mission, as I did and do today, and I suspect many, too, thought the organization was focused on the wrong things. I left the AMA because writing and podcasting about history and politics was a dream of mine, and I am blessed that I can devote my time to this.
Would I have stayed long term given this direction with this passion for history? The answer is no. At some point, the fun of my role there would have been too diminished by seeing my work squandered on leftist ideological pursuits, and that is sad.
I will tackle governmental institutions and their rot for the following podcast, but let me conclude this with the following.
Wouldn’t having a counterweight to governmental goals and aspirations be nice? Instead, we have an organization more concerned about global temperatures than curing cancer. We need an organization that would try to free people from political prisons. We need an association that protects free speech, even odious hateful speech. We need an Amnesty International or ACLU. What we have are progressive ideologues ruling these institutions for their petty purposes. Williamson summed it up nicely, “Medicine should be guided by medical criteria. When politics dominate Medicine, horrifying things happen. Those who remember the Soviet Union’s weaponization of psychiatry to crush dissent must greet with some concern about current efforts in the United States to treat certain species of political disagreement as though such dissent were a kind of mental disorder. If Americans do not entirely trust their doctors and scientists regarding matters of public controversy, there is a reason for this. The AMA and other organizations got into politics on their initiative, and it is not easy to get out.”
And that is ultimately the shame of it.
I said I would not name names, but there is one exception. I never get fascinated with so-called stars. The whole celebrity thing seems odd to me. If I see Gal Gadot or Ryan Gosling at a Starbucks, they are just popular actors and not someone I would bother for a signature or get a photo to share with my friends. But the current president of AMA is different. I met him twice briefly. His name is Jesse Ehrenfeld. He served in the Navy as a doctor in combat zones. He is an Emmy award-winning photographer, and a leader in his medical field. I prize these things higher than the fact that he is the first gay president of the AMA and think it is equally essential that he and his husband have adopted two boys. That he does all these things and is also a devoted family man impresses me far more than starring in some superhero movie.
For one conference I oversaw, Dr. Ehrenfeld handled complex technological information we had provided just days before. It was as if he had been teaching it for a decade. He is brilliant, engaging, and a decent man. This guy could find or be the next Pasteur, Roentgen, or Salk. That is why it is so bitter and disappointing that instead of leading the organization back to pure Medicine, he is seemingly doubling down on the progressive ideological narrative. Being a 147-year organization, we would hear a lot about the bad history of the AMA.
Discrimination, segregation, human experiments, not treating black patients. But instead of using that history as a warning against being ideological and just focusing on Medicine, the AMA is neck-deep in leftist narratives. This approach is bad for patients, bad for doctors, bad for the AMA, and most of all, bad for our nation.