New Disdain for the AMA

To the layperson, the AMA may seem like an ideologically infallible organization - a group of physicians working for the good of their patients.  But the truth may be that the organization really shills for a minority of clinicians and only carries the veneer of benevolence for its own (profitable) end.  Only recently, I was agnostic towards the AMA, even giving them the benefit of the doubt on some issues, but recent readings from two different clinical sources have soured me. 

The first comes from today's New York Times.  In the middle of a fairly forthcoming reflection on his own shortcomings as an ethical physician, Dr. Daniel Carlat offers this about the AMA's allegiance to profit over patient:

"The American Medical Association is also a key player in prescription data-mining. Pharmacies typically will not release doctors’ names to the data-mining companies, but they will release their Drug Enforcement Agency numbers. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money." (emphasis added)

Excellent.  The AMA, an organization whose mission is "to promote the art and science of medicine and the betterment of public health", feels that's it's in the best interest of the public's health to allow pharmaceuticals to better understand the prescribing patterns of clinicians so they can use tactical maneuvers to increase their products' market share.

But if these millions don't fill the coffers of the members enough, perhaps disguised advocacy in the form of promoting specialty reimbursement through it's RUC machinations will do the trick.  Dr. John Goodson breaks down this highly opaque and complex process whereby a group of representatives, including those from very the specialized fields of ENT, neurosurgery, and plastic surgery, set a large portion of Medicare's reimbursement schedule.  Needless to say, the RUC generally favors reimbursements for procedural work rather than primary care work - even though the vast majority of clinical research shows that primary care services are the most cost-effective clinical method of increasing the public's health. 

(Ironically, Dr. Goodson's commentary is in the AMA's journal - JAMA.  Unfortunately, this particular article hides behind JAMA's subscription service - but visit your local medical library and read the whole thing in the 11/21 edition.)