Talk:American Medical Association

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[edit] "AMA Limit"

I deleted the "AMA Limit" section entirely, as I am not aware of ANY such limit; AMA's own website doesn't mention anything of the sort. I believe that the entire idea of a "limit" on doctors is as fictitious as much of the original text of this article which has already been deleted by others.

The only limits I'm aware of on the number of doctors are limits on the number of med-school enrollees, but that's set by whoever runs the med school. (For example, the enrollment limit of Arkansas' only med school, the College of Medicine of the state-run University of Arkansas for Medical Sciences in Little Rock, is set by the Arkansas legislature.)

Most importantly, any limit of that sort imposed by a private entity (such as the AMA) would be a blatant violation of U.S. antitrust laws, especially Section 1 of the Sherman Act, and would likely risk both criminal and civil action by the U.S. Justice Department. The AMA can influence Federal and, more likely, state regulators (which are outside the reach of the antitrust laws) to set limits, but those are the responsibility of Federal and state governments, not the AMA.

--R. Brittain (not a doctor or connected to doctors in any way)

[edit] NPOV Issues

The last paragraph in this article needs some serious clean-up to meet NPOV standards.

I'm going to go ahead an excise the last paragraph entirely. It doesn't really provide any insight regarding the AMA and seems more fitting for an article regarding the relative merits of socialized health care. --Cvaneg 19:30, 8 Dec 2004 (UTC)
I decided to chop out most of the second to last paragraph too as it seemed to mostly be an argument for socialized health care. --Cvaneg 19:40, 8 Dec 2004 (UTC)

I revised the criticisms section, which I do understand is supposed to have a POV, but it still read a little too much like a rant against the AMA. I also threw out some statistics that I don't really think illustrated much of anything. In particular, the rejection rate from a single school for a single year (Does not illustrate overall acceptance rates. i.e. Students who have been accepted to one school vs. students who were accepted to none), and the population vs. the number of med schools (A better statistic would be increase in doctor population vs. overall population.) --DaveC 02:36, 4 Mar 2005 (UTC)

The article is definitely one-sided. The AMA is such an enormous and complex organization, yet 50% of the article is devoted to what Dr. Henry Jones "contends". Edwardian 20:19, 22 Apr 2005 (UTC)

These three sentences do not reflect the current political positions or policy of the AMA nor do they supply full context for their historical positions and policies: "The AMA has traditionally opposed publicly funded medicine. In the 1930s, it attempted to prohibit its members from working for the primitive health maintenance organizations that had sprung up during the Great Depression; its subsequent conviction for violating the Sherman Antitrust Act was unanimously affirmed by the U.S. Supreme Court. American Medical Ass'n. v. United States, 317 U.S. 519 (1943). Its vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan" I have removed them. Edwardian 21:32, 22 Apr 2005 (UTC)

"In the 1990s it was part of the coalition that defeated the health care reform proposed by President Bill Clinton." As above. Edwardian 21:47, 22 Apr 2005 (UTC)

An article can and should give information about notable aspects of the subject's past. The article on Robert Byrd has a whole section on his participation in the KKK, which clearly doesn't reflect his current position. If the AMA has changed its views on some of these subjects, feel free to add an update. If the article fails to "supply full context for their historical positions and policies", feel free to amplify on the context. So far I see nothing that shows the deleted information to be inaccurate or irrelevant, so I'm restoring it. Also, the AMA's demonizing of medical malpractice victims is the AMA's (extremely biased) opinion; it can reasonably be included but it must be attributed to the AMA, not stated as if it were fact. JamesMLane 22:14, 22 Apr 2005 (UTC)
Regarding "If the AMA has changed its views on some of these subjects, feel free to add an update." I did add an update and amplify the context of what the AMA's current political positions are but you deleted it:
The AMA officially "continues to oppose attempts to cut Medicare funding or shift increased costs to beneficiaries at the expense of the quality or accessibility of care" and "strongly supports subsidization of prescription drugs for Medicare patients based on means testing".
Regarding "So far I see nothing that shows the deleted information to be inaccurate or irrelevant, so I'm restoring it." As far as I am concerned, I see nothing accurate or relevant about the deleted information so it should be deleted. The burden is on the author to prove information accurate or relevant, not on me to prove it inaccurate or irrelevant. But I'm happy to take it line by line:
1) "The AMA has traditionally opposed publicly funded medicine." I just provided information regarding their official position which directly contradicts that assertion as inaccurate.
2) "In the 1930s, it attempted to prohibit its members from working for the primitive health maintenance organizations that had sprung up during the Great Depression; its subsequent conviction for violating the Sherman Antitrust Act was unanimously affirmed by the U.S. Supreme Court. American Medical Ass'n. v. United States, 317 U.S. 519 (1943)."Given that the title of the section is "Political positons" and that that assertion doesn't state anything about a "political position", it is irrelevant information in that section. Put it in "History" if you want.
3) "Its vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan." Again, this is not a current political position. Put it in a section entitled "History" and we can add more to it there.
4) "In the 1990s it was part of the coalition that defeated the health care reform proposed by President Bill Clinton." So what is the specific political position that is being referenced with this assertion? That their position is not President Clinton's position?
I think the biggest problem I have with this article is the minutia being presented to push some sort of agenda. It's akin to trying to build the President Clinton article around the statement, "He was the guy who got his c*ck sucked." (Sorry for the length of this reply.) Edwardian 00:32, 23 Apr 2005 (UTC)
I don't mind at all the length of your reply. Instead of vaguely alleging bias, you chose to deal with specifics, which is the only way we can make progress but which of course makes for long comments (and responses -- as you're about to discover!).
With regard to my suggestion that you should add an update if you thought it important: You didn't just add an update; you completely removed all the information about the AMA's political stance before the enactment of Medicare. By contrast, the language that you say I removed is still in the article, except that I reworded it slightly so as not to assert, as a fact, that the AMA's actual motive in supporting higher physician reimbursement is to help seniors. (I personally don't think that's the actual motive. I stated the objective fact that we know, namely that that's the point the AMA has publicly advanced as an argument.)
  • Your point #1: The AMA opposed public funding when it was an issue. You're correct that, now that they've lost that battle, they continue to act in their own self-interest, and since they have no hope of ending Medicare they try to milk it for what they can. Nevertheless, we should clarify the timing. I didn't write the "traditionally" passage, and I edited the article to say "With Medicare in place, however, ...." with the idea of conveying that the previous discussion applied to pre-Medicare years, but it can't hurt to spell that out more explicitly. I've essayed a rewording.
  • Your point #2: I think this is reasonably related to the AMA's overall stance. The action described doesn't involve an electoral campaign, but I'd consider it political. In any event, regardless of how this material should be organized, it's not appropriate to delete information entirely just because you think it belongs in a different section.
  • Your point #3: More clearly political, and the heading doesn't say "Current political positions".
  • Your point #4: Sorry, I don't understand your question. There was a political issue -- should the U.S. adopt Clinton's proposal? The AMA took the "No" position on that particular issue. The passage clearly says that. Do you mean you think it implies that the AMA opposed Clinton generally?
As to your final comment: Because Wikipedia is a volunteer project, it often happens that an article is unbalanced. Participants contribute what they're interested in, not what some overriding editorial authority has decided is most important. We have articles on minor Star Trek characters, but some Emperors of China are still red links. The solution to that kind of imbalance is not to delete accurate information, but to supply what's missing. If the article on Clinton consisted solely of a reference to the Lewinsky affair, I wouldn't delete that reference. Instead, I'd add the material I considered important. Here's the relevant Wikipedia policy:
An article can be written in neutral language and yet omit important points of view. Such an article should be considered an NPOV work in progress, not an irredeemable piece of propaganda. Often an author presents one POV because it's the only one that he or she knows well. The remedy is to add to the article—not to subtract from it. (from Wikipedia:NPOV tutorial#Space and balance)
In this instance, it's not even a case of presenting only one POV. The article doesn't give the arguments for saying why the AMA was wrong in earlier years; it simply reports what the organization did. Therefore, there's even less justification for subtracting from the article. If you think that the article would be better balanced if it had a "History" section that recorded all the good things the AMA has done, feel free to add such a section. JamesMLane 14:48, 25 Apr 2005 (UTC)
Are you saying that I specifically allege bias rather than vaguely allege bias! Anyway…
  • Point #1: There is no doubt that the AMA is acting in their self-interest, but some might express that POV differently: “Although the AMA has little hope of regaining what they lost in the battle against socialism, they continue to act to hold onto what freedoms are left in healthcare.” Although I appreciate the change you made to make the statement more accurate (i.e. “The AMA has traditionally opposed publicly funded medicine.” to “For much of the twentieth century, the AMA opposed publicly funded medicine.”), here are some points that I think should still be addressed:
  • a) The term “publicly funded medicine”. Although most people are familiar with terms such as “socialized medicine”, “socialized healthcare”, “nationalized medicine”, “nationalized healthcare”, “single-payer health care”, and “universal health care”, somehow the choice to use “publicly funded medicine” was made here. I think that is a poor choice of words for a number of reasons:
  • i) The use of that term outside of Wiki is not well known. Try Googling “publicly funded medicine” and you’ll find that the hits that do not bring you back to Wiki are few and far between.
  • ii) Wiki articles should reflect terms in use outside of Wiki, not those primarily created, or whose meaning has been defined, within Wiki. (As above.)
  • iii) The term is vague and allows room for equivocation given that not even the Wiki definition states whether it applies to medical service for some citizens (e.g. Medicare or Medicaid) or medical service for all citizens (e.g. the NHS in the UK). So stating that the AMA opposes or opposed publicly funded medicine has no clear meaning.
  • b) With that in mind, the AMA briefly supported compulsory health insurance around 1915 but since then has traditionally opposed any compulsory program that would lead to a nationalized healthcare system; but it has traditionally been in favor of tax-supported medicine for the poor or indigent.
  • Point #2: I do think this would be better suited in a “History” section given that it does not reflect the AMA’s current position. To satisfy my own curiousity of the issue (which may reflect that of other readers), I also think a statement why they took the position they did would be warranted.
  • Point #3: Nor does the heading say “Past political positions”. In my opinion, uninformed people referencing this article would want to know what the AMA is before they want to know what it was. I do think a discussion of the AMA’s initial opposition to Medicare is warranted, but I also think it should include substance (perhaps linking to the article of one of the aforementioned issues that have been hijacked…er, redirected to publicly funded medicine) more so than trivia (i.e. Operation Coffecup).
  • Point #4: In my opinion, the article clearly states that the AMA opposed a position, but what that position was or why they opposed it is not clear. Let's work on this one.
Regarding your final comments, I think there is a difference between using neutral language and presenting a NPOV, and I do disagree that the solution to a successful Wiki article is to keep every possible factoid presented. Wikipedia:NPOV tutorial#Space and balance does also state: "Different views don't all deserve equal space. Articles need to be interesting to attract and keep the attention of readers. For an entry in an encyclopedia, ideas also need to be important [emphasis mine]. The amount of space they deserve depends on their importance and how many interesting things can be said about them." In my opinion, to get around that by stating that "it's all I know" or "it's a work in progress" is a bit weak. Still I will admit that it's difficult to know whether or not someone is presenting the only POV they know, or is blatantly violating the NPOV policy. Edwardian 15:51, 26 Apr 2005 (UTC)
Several of your comments refer to information that could usefully be added to the article. I see no problem with factual additions, but I don't think the NPOV tag should stay on while we wait for the article to move closer to perfection. Would you agree to the removal of the tag? Nothing in here now is a "factoid" (in the sense of something so trivial it should be removed).
As to "publicly funded medicine", it is indeed a broad term. It covers socialized medicine but also more limited government programs, like Medicare (which couldn't appropriately be described with any of the alternatives you mention). Its Google ranking doesn't bother me. A term like "single-payer" is jargon that isn't familiar to everyone, but "publicly funded medicine" is just a description. Its meaning should be obvious to most people. Still, if it bothers you, what would you think about "the AMA opposed any government role in paying for health care"? JamesMLane 00:45, 27 Apr 2005 (UTC)
I don't think the article yet presents a NPOV. I think the "Political positions" section inaccurately portrays the AMA's political history (although we're working on it) and the Criticism section, which comes across as though someone has an axe to grind, could be reduced to one sentence that says the same thing: "Critics assert that the AMA influences state medical licensing boards to limit the supply of licensed physicians in order to raise physician wages, which they claim leads to increased health care costs and a decreased quality of health care."
I don't think "publicly funded medicine" is an description that accurately or specifically describes anything. If we are going to use that particular term, it should be noted again that the AMA has traditionally been in favor of tax-supported medicine (i.e. publicly funded medicine) for the poor or indigent. For that reason, for the article to state that "the AMA opposed any government role in paying for health care" is not true. Edwardian 04:07, 28 Apr 2005 (UTC)
(FYI, it was not I who made the large changes to the criticism section earlier today/yesterday. Edwardian 15:50, 28 Apr 2005 (UTC))

-

Regarding my edits, please cite your sources so your statements have credibiliy. DrThompson 02:15, 9 August 2005 (UTC)

If the original writer of that text ever happens to read this, I doubt that he/she will have any idea of what you are talking about. Edwardian 03:16, 9 August 2005 (UTC)


--Coolcaesar 06:02, 25 October 2005 (UTC)== NPOV (the sequel) ==

It seems (at least most of) the POV issues have been resolved. Any objections to taking down the POV dispute flag?FRS 16:57, 25 October 2005 (UTC)

  • Although I am not a fan of the organization, the article still seems overwhelmingly critical of the AMA. I think the flag should stay. Edwardian 05:16, 25 October 2005 (UTC)
    • I concur. I feel that the AMA has been more inept, if anything, than malvolent or destructive. --Coolcaesar 06:02, 25 October 2005 (UTC)
I deleted one unsourced dig at the AMA regarding social security and corrected the history about the chiropractor/antitrust case as well as links to the partisan chiropractor website. There are probably other things in the article that some will find overly critical to the AMA. IMO, however, it is a fair criticism made by reputable sources to observe the AMA, like any professional guild, has the effect, if not the specific objective, of limiting entry into the guild and competition with it. I hope we can get consensus on a NPOV version of this article soon.FRS 16:57, 25 October 2005 (UTC)
I removed the POV flag in the expectation (hope?) that edits made on 10/25 and 10/27 are enough too make the article sufficiently NPOV. --FRS 22:18, 3 November 2005 (UTC)
I still think the article reflects a critical bias. I'm going to put up an RFC to get some more input on this. Edwardian 05:47, 4 November 2005 (UTC)
I came here as a result of the RFC, and I believe the article is still terribly POV.
I question the Jones Steinreich article as well. I'd encourage anyone who believes JonesSteinreich to also read The Great Influenza by John M Barry to get some perspective. The state of medical education prior to the Flexner Report was deplorable.
The medical schools that were closed typically didn't have a single microscope; students weren't trained in ANY clinical work; some schools that were closed still taught bleeding as a useful treatment for influenza; schools that didn't require a college degree. Furthermore, Flexner was comparing U.S. Medical schools to their German counterparts and drawing extremely unflattering comparisons. HIs report should not be denigrated in such a way.
So, I'm certain that there are very few medical historians who would find fault with the Flexner Report. I don't know Dr. Jones's Steinreich's work, but he doesn't appear to be mainstream on this issue.
Furthermore, the denigration of Abraham Flexner in the article is unfair and quite spurious. For goodness sakes, at one point he was Albert Eisntein's boss.
Having said that, I have no knowledge or opinion about the "supply" of doctors. There may be something there. I just don't support the criticism of the Flexner report without mentioning the contents[1] of the report. This article is most definitely anti-AMA POV, IMO.Danlovejoy 05:41, 5 November 2005 (UTC)
I can't find a mention of Flexner in the article--FRS 01:48, 17 November 2005 (UTC)
Oops. My criticisms are of the Steinreich article, the #4 reference. They still apply. Danlovejoy 04:01, 17 November 2005 (UTC)

[edit] Still POV

Per the discussion above, I have restored the POV tag. What need to be done to move this article toward neutrality? Danlovejoy 00:51, 17 November 2005 (UTC)

I'm not sure the Friedman critique et al. needs to stay here. My understanding was that Friedman's critique was of professional licensing in general; he also attacked lawyers at the same time. Furthermore, his theories have since been attacked due to newer research in economics and information science into irrational behavior and the asymmetrical distribution of information. --Coolcaesar 12:11, 17 November 2005 (UTC)
I would be OK with taking out the second para of the "criticisms" section sourced to Steinrich, if the rest of the section is left intact. I think the criticism of Friedman and others that the AMA is a guild deserves space in the article, however. Of course, if there's a rebuttal to that criticism, we can discuss it and add a reference to it. FRS 16:15, 17 November 2005 (UTC)
In my opinion, this section of the article should reflect general criticisms of the AMA, not the specific criticisms leveled by any one particular person. Otherwise, it is destined to become a compilation of opinions on the AMA by notable people. Given that Friedman and Steinrich (and even Jones) are essentially making the same point, that is "the AMA conspired/conspires to decrease competition in order to raise physician wages/fees". I feel that trimming down this section, while retaining the essential information, would make the article less POV.
Critics of the American Medical Association have asserted that the organization has attempted to increase physicians' wages and fees limit by influencing limitations on the supply of physicians and non-physician competition (insert footnote links to Freidman, Steinrich, and Jones here). They assert that these actions have not only inflated the cost of healthcare in the United States, but have also have caused in decline in the quality of healthcare (insert footnote to Jones here).
--Edwardian 19:43, 17 November 2005 (UTC)
I'm OK with shortening the criticisms section 'proximately as you suggest. I think it should include links to guild and Friedman, however, like this
Critics of the American Medical Association, including economist Milton Friedman, have asserted that the organization acts as a government-sanctioned guild and has attempted to increase physicians' wages and fees limit by influencing limitations on the supply of physicians and non-physician competition (insert footnote links to Freidman, Steinrich, and Jones here plus [2]). They assert that these actions have not only inflated the cost of healthcare in the United States, but have also have caused in decline in the quality of healthcare (insert footnote to Jones here).
any objections? FRS 20:32, 17 November 2005 (UTC)
Excellent, FRS! I disagree with the inclusion of the Steinrich article- it's pretty crazy. But if we decide it needs to be included, I'll live with it. Danlovejoy 22:02, 17 November 2005 (UTC)
Although I don't think naming Friedman is necessary, I'm OK with the change including the reference to the Steinrich article. Below is the change, with footnotes from Friedman, Woods, Steinrich, and Jones. Anything else?Edwardian 22:30, 17 November 2005 (UTC)

I think this is fine. I don't have any problem taking out the Steinrich link, all those articles are from the same place (LvM Institute, which we should wikilink, by the way.) Thomas Woods also has a page here already.

[edit] Proposed change to "Criticisms" section (open to edits)

Critics of the American Medical Association, including economist Milton Friedman, have asserted that the organization acts as a government-sanctioned guild and has attempted to increase physicians' wages and fees limit by influencing limitations on the supply of physicians and non-physician competition [3] [4][5][6]. They assert that these actions have not only inflated the cost of healthcare in the United States, but have also have caused in decline in the quality of healthcare [7].

[edit] Request: government-sactioned?

I came to this article for one pice of info, and didn't really find it. How "government-sanctioned" is the AMA? Everything in the article seems to indicate it is a completely private lobbying organization, except I have two problems with that: (1) The criticism secion has a reference to it as "government-sanctioned," and (2) I'm pretty sure it would be illegal for me to practice medicine without some sort of AMA license. If there is a legal requirement for practicing medicine and it involves the AMA in some material way, I think it should be present in this article. Anyone more knowledgable want to help me out? NereusRen 20:12, 28 March 2006 (UTC)

The AMA is like the ABA; it's totally voluntary (I have several relatives who work in healthcare). Licensing is done at the state level by Medical Boards. After getting the M.D., American physicians take an examination offered by the National Board of Medical Examiners, an independent organization which has liaisons with the AMA but is not part of it. The NBME then issues a certificate which physicians show to a state Medical Board to get a license to practice in that state. The advantage to this system is that unlike lawyers, American physicians can take one exam and then practice anywhere, while American lawyers generally have to take the essay portion of the bar exam (or the entire exam again, depending upon the state) for each state in which they practice. The reason is that American law varies widely from state to state (for example, some states have community property, which drastically affects how a lawyer deals with married clients), but medical practice is mostly the same everywhere.
There are also several other independent national boards which offer additional certifications for all the major medical specialties, which is why some specialists call themselves "board-certified." --Coolcaesar 18:42, 29 March 2006 (UTC)
Actually, physicians, after taking their NBME exams, cannot simply show the results to a state medical board to get a license. The licensing process is much more in depth, and many states require their own oral or written exams (example, CA, FL, ME, etc.) depending on the recency of a physician's NBME exam scores. The AMA is not government-sanctioned at all. It is simply a membership organization for physicians that serves as a federation of all other american medical organizations. It is run by a Board of Trustees through policy set by a House of Delegates that meets semi-annually. The House delegates are from state and specialty physician organizations around the country, and the meetings usually have upwards of 1000 participants. About 30% of physicians are members of the AMA, but nearly 100% are members of at least one of the organizations that have representation in the AMA. Drgitlow 02:41, 28 July 2006 (UTC)

[edit] Removal of section

In both American Medical Association and Joe Schwarz, I am removing the section regarding the “postcard controversy” as an unverifiably notable incident.

In response to receiving a mailing that he interpreted as a slur against peace activists, Terry Calhoun explained in a web column that he posted about the experience in American Medical Association and Joe Schwarz; he admittedly characterized these actions as an empowering “'political' use” of Wikipedia. Calhoun, who can easily be verified as User:Splendid by examining Calhoun’s statements and the edit histories of the Wikipedia articles to which he referred, also placed links to another website he maintains, http://splendid.backpackit.com/pub/689592 , into both articles. Adding such a personal experience violates various Wikipedia policy (i.e. certain subsections of Wikipedia:What Wikipedia is not, including “not a publisher or original thought” and “not a soapbox”) and guidelines (i.e. Wikipedia:Autobiography and Wikipedia:External links’s “Links normally to be avoided”).

The only independent reference to this story is an article in the Ann Arbor News/Mlive.com which came on the heels of a press release from a group of peace activists in Michigan; the article extensively quotes that group and Calhoun. -AED 23:06, 6 September 2006 (UTC)

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