The Constitution --- Plain and Simple
Medicine --- An Industry
or a Profession ---
Part I: AMA Recruitment
Curtis W. Caine, MD
Part I begins with an AMA recruitment letter from J. Edward Hill, M.D., a member of the AMA Board of Trustees, and the author's response. At the same time, an interview with Dr. Hill was published in a local Mississippi newspaper.(1) This exchange sets the tone for the discussion that follows.
Even though the Constitution does not authorize Congress and the federal government to interfere in the practice of medicine, the government has done so, and therefore, we will also use the rallying point of the Constitution to proceed under this heading: Is medicine a profession or a trade union or an industry? Do we serve our patients or the health of the nation?
We NEED your participation as a member of the American Medical Association and the Mississippi State Medical Association.
These are critical times and there are many forces interfering with the physician-patient relationship. AMA and MSMA are on the front lines working for patients and physicians; and we are redoubling our efforts to reduce and eventually eliminate the "hassles" that cause such a burden in your practice and intereferes with your ability to provide quality care to patients.
The past year or so has caused all of us in organized medicine to re-examine our principles and then reaffirm our ethical standards, which have not changed in our 150 year existence. This resulted in critical changes in the organizational structure of the American Medical Association to make it stronger and more responsive to physician members.
This is a time of special need in American medicine. Professional organization activity and support is the only means by which large group pressure on legislation and bureaucratic processes can help physicians preserve patient choice. The forces of acquisition and coercion are threatening to reduce the individual needs and responses of patients to assembly line medicine, and to create an even more prevalent "cost-before-quality" syndrome.
Each of us can make a difference; we need your help in organized medicine. Please join the AMA and the MSMA now and you can take advantage of the significant AMA dues reduction for physicians in Mississippi. Contact the MSMA Director of Membership for a membership application if you do not already have one.
J. Edward Hill, MD
Your "Dear Colleague" letter of April 6 received on the 7th...I hope and trust that someone else actually wrote it and fraudulently affixed your signature to it without your knowledge or proofreading.
Correction A: The subheading says that the AMA is "Physicians dedicated to the health of America." That is very interesting. I have always thought (and believed) that Doctors of Medicine attend, care for, and treat sick individual animate humans, not the "health of America," "society," or the collective! The "health of America" is graded on financial, moral, political, and Constitutional assay.
On the other hand, the health of humans is determined on a thorough medical history, physical examination, laboratory studies, experience, and a high index of suspicion. So, at the outset, the subtitle makes me suspect some amateur has accidentally mis-set the AMA's sail. The alternative is that a professional set the wrong course on purpose, for ulterior motives (including pecuniary and status profit). In either instance, a re-trim must be made and those responsible summarily fired post haste, or continued catastrophe is assured. The old adage "garbage in --- garbage out" is à propos.
Collective (government/third party) medicine is veterinary medicine --- in (under) which the owner (the one who pays the bill --- the federal government and its third party co-conspirators) determines if care is given (rationing), what the restricted "official" diagnosis is (CPT coding), what care is given to the cat or dog or horse "patient" at the whim of the owner ("approved" procedure --- i.e., spayed, put away, etc.), by whom (credentialed, CME requirements, "malpractice" limits), when ("authorization"), where (JCAH "accredited"), how much or little treatment is given ("pathway"), for how long (length of stay), and for how much ("allowed," "approved" wage and price control). This whole process is immoral, illegal, inhuman, retrogressive, and reprehensible in the practice of medicine. Therefore, individual ethical physicians and "organized medicine" (the AMA and the Mississippi State Medical Association [MSMA] and the specialty societies) must reject all of this, not just resist or attempt to "reform" or negotiate.
Correction B: I am further disturbed by paragraph 2, line 1 where you write: "These are critical times and there are many forces interfering with the physician-patient relationship. AMA and MSMA are on the front lines working for patients and physicians; and we are redoubling our efforts to reduce and eventually eliminate the 'hassles' that cause such a burden in your practice and interferes, with your ability to provide quality care to patients." The term "physician-patient relationship" is out of phase. The only necessary ingredient in the whole affair is a sick patient. Without him no hospital, no pharmaceutical house, no helicopter, no nurse, no doctor, no brace maker is needed --- and you and I are useless drones. To indicate priority and supremacy, the proper sequence is "patient-physician."
Correction C: In the same paragraph, last line, "interferes" should be plural and have no "s" on it. "Cause" in line 3 is plural and correct. I know your grammar would have been proper, so my suspicion of a high school freshman ghostwriter is strengthened.
Correction D: You also praise the MSMA and the AMA, but they are major parts of the problem. I was a member of the AMA from 1945-1974, and a Fellow of the AMA. You probably do not know there was such! I was a member of the MSMA from 1948-1985.
I dropped my AMA membership when I finally realized the AMA not only did not represent me but actually misrepresented me, and thus was my enemy. Many MDs in Mississippi and throughout the U.S. have come to the same conclusion such that just 27 percent of practicing physicians are AMA members. In the Associated Press article,1 you give a slightly higher figure which includes non-practicing MDs matriculated into the AMA by their employers in industry, academia, public health, the armed services, government agencies, etc. and, I suspect, interns and residents (maybe even medical students).
The decline in AMA membership, contrary to your assertion, is not because the dues are outlandish (which they are), but due to the fact that those of us who have gotten out (and many more that want to and are going to) are outraged by the constant compromising and cohabitation of the AMA with government. Government is forbidden by the Constitution of these American States to be in medicine to any degree, period. That should be the constant, uncompromising position of the AMA. It must be for me to be a member. That the AMA is paid by HHS to devise, promote, and institute the socialist anti-patient and anti-physician programs of the self-appointed monarchy in Washington is treason to both of us.
The three-fourths of us intentionally out of the AMA are screaming at you that we don't like what you are doing (I repeat, not that the dues are too high) and we won't pick up the tab for the betrayal.
In addition, doesn't the fact that only four of the 54 component medical associations in the AMA are "unified" tell you something? When there were only two several decades ago (Illinois and Oklahoma) the MSMA's arm was twisted by AMA President Bornemeyer and the MSMA hierarchy, the argument being that we were "free loaders, outside the mainstream, benefitting from the AMA without paying our fair share of the cost" (almost a direct quote, word for word). And the milquetoast MSMA House succumbed, becoming number three. That laborious drive garnered other states to a total of just nine. Five of which subsequently wised up and withdrew, leaving the four you list still "unified." Very recently, the Illinois Medical Society (home of the AMA!) missed deunifying by just one vote. Wake up Colonel Nicholson.(2)
The pseudo-eminence of the AMA even shows in that JAMA is now a pamphlet. Decades ago it was over a half inch thick each week. The Sunbeam scandal shows the industry mentality of the entrenched Chicago lay and non-practicing staff of collectivists that leads you members of the Board of Trustees around by a ring in your nose. The practice of medicine is a profession of honor, not an industry.
The perfidious and exclusive copyright CPT code contract with HCFA (worth at least $10,000,000, perhaps $15 million, per annum to the AMA) is infuriating. Private/government collectivist partnership is fascism. The AMA now brags CPT is en español, its "first second-language version." Note the repeated prominence of CPT being "TM" (Trade Mark). And the price is not forgotten, of course, because it means more $millions.
The AMA has gone global. Don't forget that the intent of the new world order is to have just one international health system. And one everything else --- money, court, army, etc. --- being implemented as I write. Vladimir Lenin said "Medicine is the keystone in the arch of the socialist state." AMA is positioning itself to be the key player.
Seventy percent (your figure) of the AMA's annual revenue of $200,000,000 coming from sources other than member dues means, ipso facto, that 70 percent of the AMA's activities, positions, and time serve the interests of those entities rather than the members. He who pays the piper calls the tune. Don't you realize that? And don't you know I comprehend that? If you are so altruistically interested in "serving" your colleagues in the capacity of a Trustee, then do so at your own expense, stay in Motel 6, ride in the back of the jet, meet in central St. Louis instead of Bora Bora. I do in AAPS. Or relinquish your ego trip to one who will put service ahead of status and who will do it pro bono.
All of the intrusive shackling of the practice of private medicine (PRO, PSRO, Medicaid, Medicare, HMO, CPT, JCAH, fraud and abuse, E & M, FDA, OSHA, etc., et cetera) are AMA supported and sponsored. HHS even paid the AMA to implement several of them.
In addition to all of these being unConstitutional (therefore participation in any one of them is a criminal act), sections 1801, 1802, and 1803 of PL 89-97 (the Medicare law of July 30, 1965) forbid the Fed to mess with medicine.(3)
So, the AMA's and the MSMA's position must immovably be "NO" to any and all third party abridgement. But the AMA is particeps criminis. And MSMA is AMA's co-felon, and when they ask me to join them, they, in effect, urge me to be particeps, also.
You say "...our ethical standards...have not changed in our 150 year existence." C'mon, Ed. You (and I) know better than that. I'm insulted to be presumed to be so dumb and gullible, by whoever wrote your letter, that I'll take your (her) word for it. The present AMA Code of Ethics bears little resemblance to its Code of 40 years ago. Hippocrates has been banished for decades. A physician's professional ethic includes no responsibility or duty to the collective ("society"). Physicians must eschew murder (abortion or assisted suicide and euthanasia).(4) Political consensus is not an acceptable yardstick.
Neither the AMA nor the MSMA come anywhere near measuring up to the standards I require for them to merit my being a member. My long standing position still holds. When you do reverse your stance and hold to principle without compromise, I'll consider voluntarily rejoining either or both.
As you can see by the date in the heading, this letter was commenced several weeks ago. I have been prompted to delay mailing it because I have had a sense of incompleteness. Something has been lacking, I have felt. Well, now I know why the procrastination. The AMA, earlier this month, filled in the void - its call for unionization has done it.
An industry has management and labor. Labor works for management. Management controls labor. Such a pecking order sticks in the craw of "labor." Individual laborers have little say-so in running the business, they feel. So, workers, to have enough "clout" to give orders to the boss, are cajoled into forming a union, and (with the aid of government) they (now "it") tell the owners of the business, the boss, what hours they will show up, when they will eat lunch, how many potties will be available and where, what their pay will be, etc. ad nauseam.
By any stretch of the imagination do you think individual laborers in manufacturing run "their" unions? Of course, you know the answer is "no." The union thugs run the union. That means the mobsters run the show! So, an individual worker has been duped into surrendering his individual freedom to become an insignificant nobody in a mass movement, swapping his rightful boss from the owner of the business, his employer, to union bosses (many of them just one step ahead of the sheriff). Additionally, unions are under the thumb of the Fed. So, workers are no longer the servants of their employer, but hogtied pawns of the mafioso and its cohort, coercive government.
Ah, but you may counter that physicians are gentlemen, and labor union heads are crooks. Really? These very "gentlemen" voted a few days ago to unionize! And if you think things will be better in a doctor industry labor union than they are in a manufacturing industry union, I want to interest you in a wonderful lot I have in central Florida where you can build your dream home. Not incidentally, the address is Everglades, Florida.
Ergo, you have made a horrible situation exponentially worse. You have lowered our esteemed, venerable profession to the status of a servile bargaining panel. Not in which an individual patient voluntarily, mutually, personally, agrees with his individual physician as to diagnosis, tests, treatment, and fee; but in which outsiders arbitrarily, coercively set all of them. And "doctors" will have to abide, or try to sell real estate. Eventually, certain laborers will be selected and forced into the health trade against their will, and made to continue to "practice" medicine, if they want to eat. Again, the veterinary ethic! The owner is making all the decisions for the animal.
Preposterous? In their "new world order" that's the way the planners intend it will be. That's what "school to work" is all about. The word "labor" is a noun, an adjective, and a verb --- to labor --- that is, forced to work. The present covetous, gluttonous policies of the AMA and the MSMA are embroiled in imposing this holocaust on the medical profession.
I beg of you --- wake up! Look at what happened in Germany, Italy, Russia, Canada. It does not have to happen in America. But it is fast concluding - and, incredulously, with the aid of the "organized medicine" you want me to join!
Curtis W. Caine, MD
1. Tupelo doctor wants to pump life into AMA. Clarion-Ledger, March 15,
2. Main character in the movie, Bridge Over the River Kwai.
3. Title XVIII - Health insurance for the aged. Medical Sentinel 1999;4(6):221.|
4. Proceedings of the Chicago meeting. JAMA 1956;162(5):504-505. Since then, the AMA Principles of Medical Ethics were simplified and codified to the AMA Principles of Medical Ethics (1996). This simplification paved the way for the corporate practice of medicine (and subsequent deletions of Sections 6 and 7) and the rejection of the ethics of Hippocrates (via the deletion of Section 8) which has removed further obstacles for assisted suicide and euthanasia. Note that the trend is now for avoiding futile care, pursuing death with dignity and the rational allocation of resources rather than "seeking consultation in doubtful or difficult cases."
Dr. Caine is an anesthesiologist in Jackson, Mississippi, and a member of the Editorial Board of the Medical Sentinel.
Dr. Caine is an anesthesiologist in Jackson, Mississippi, and a member of the Editorial Board of the Medical Sentinel.
Originally published in the Medical Sentinel 2000;5(1):24-26. Copyright©2000
Association of American Physicians and Surgeons (AAPS)