Why does the American Medical Association support pro-tobacco candidates?

During the campaign season that culminated in November’s election, those senators who blocked comprehensive tobacco control legislation sponsored by Arizona Republican John McCain were rewarded with thousands of dollars in contributions from cigarette manufacturers–and thousands more from U.S. physicians.

Strange bedfellows, indeed. According to Federal Election Commission records published by the Center for Responsive Politics, the American Medical Association’s political action committee (known as “AMPAC”) gave over $8,500, on average, to senators facing reelection who helped kill McCain’s proposal in June. The defeat of this legislation, which would have increased cigarette taxes and granted the Food and Drug Administration authority to regulate tobacco products, effectively ended tobacco control efforts in the 105th Congress.

By comparison, AMPAC gave less than $2,500, on average, to senators up for reelection who had tried to move the McCain bill forward. That’s more than a 3:1 ratio in favor of pro-tobacco senators and begs the question: Why does a group that represents 250,000 physicians preferentially fund the supporters of an industry that annually kills 400,000 Americans?

No scientific reversal explains the AMA’s backing of tobacco’s friends on Capitol Hill. The nation’s largest physicians group remains committed, in the words of a recent leader, to “take the war to the tobacco companies in every way that we can.” In addition to supporting anti-smoking initiatives, the AMA has called for investors to divest from tobacco stocks and for politicians not to accept money from the tobacco industry. After the Senate vote in June, Dr. Randolph D. Smoak, Jr. of the AMA’s Board of Trustees, declared that his organization “deeply regrets the Senate’s failure to pass landmark anti-tobacco legislation.”

Yet not a month later, AMPAC contributed thousands to help pro-tobacco Senators Kit Bond from Missouri and Sam Brownback from Kansas beat back Democratic challengers. The PAC then went on to give the legal maximum–$10,000–to Ben Nighthorse-Campbell, a Colorado Republican who voted to block the McCain proposal and who faced an anti-tobacco opponent.

* Two studies published in the April 18 issue of the Journal of the American Medical Association report that moderate consumption of ethanol is associated with cardio-protective effects for heart attack survivors and older persons at risk for heart failure.

The first study, conducted by researchers at Israel Deaconess Medical Center in Boston, monitored patients for a four-year follow-up period to assess the effect of prior consumption on long-term mortality among 1,913 heart attack survivors. Among the 896 abstainers, 6.3 deaths per 100 person-years were reported; 3.4 deaths for the 696 light drinkers (under seven drinks per week); and 2.6 deaths for 321 moderate consumers (seven or more drinks per week).

In the second study, researchers at Emory University in Atlanta examined the monthly drinking habits of 2,235 men and women 65 or older and reported that moderate consumption was associated with decreased risks of heart failure in this age group.

A consensus document by the American Medical Association (AMA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA) establishes a single standard for evaluating the management of diabetes in adults in multiple settings. The document coordinates measurement sets used by physicians, health care plans, hospitals and other health care organizations. The diabetes care measures will be tested in a demonstration project designed with the Maine Medical Assessment Foundation (MMAF). The three health groups plan to release similar performance measures for evaluating cardiovascular disease care, neonatal care and pregnancy outcomes. “The diabetes measures are the first in what we expect to be a series of collaborative measurement sets on clinically important topics. We also see this model as an excellent example of the evidence-based approach advocated by the National Quality Forum,” said AMA Executive Vice President E. Ratcliffe Anderson, Jr., M.D. Former AAFP President Neil Brooks, M.D., Vernon, Conn., represented the AAFP on the physician consortium that developed the measures.

Greetings, and welcome back to the AMAA Journal!

I’m thrilled to re-launch the journal of the American Medical Athletic Association. It’s been a year since our last issue, and there have been a lot of changes with your association.

* We’ve updated our information technology systems, and are now overhauling our business processes.

* We have a new executive director and many new staff.

* New programs and services are in the offering. We’ve just launched our new AMAA web site. Check it out at www.amaasportsmed.org.

* Even this publication has a new title and a slightly changed format. We plan to make bigger changes to the journal over the next year.

We’re making these changes with one goal in mind; to serve you better. As I write that phrase, I’m aware how hollow that phrase may sound to those of you who, because you haven’t been members very long, don’t know us well. From time to time, my mail delivers advertisements that offer a similar claim: some megalith is doing something new or different, “to serve me better.” Riiiiight! In most national organizations, that seems to be the rule.

If you’ve been an AMAA member for a while, you know we’re different. We strive to know each member. Many of you are participants in the Clinic or the Speakers’ Bureau. Or, you participate in national programs like last year s “Stay Fueled, Stay Cooled.” We see you at the Boston Marathon and at other races. Hundreds of you have attended the CME symposia at Boston and the Marine Corps Marathon. We treasure those personal contacts with you; those opportunities build the bonds that make AMAA an exception to the rule.

So, with that in mind, allow me to bid a fond farewell to a familiar face, and introduce you to several new ones (I said there were lots of changes in our office!).

Since our merger with the American Running Association, the American Medical Athletic Association enjoyed the talents and exuberant enthusiasm of Executive Director Susan Kalish. In early December, Susan moved on to the National Recreation and Parks Association (NRPA) to tackle new professional challenges as NRPA’s Director of Communications. We are indebted to her for her leadership, creativity, warmth, and friendship over the years. Although she will be missed in our day-to-day operations, she continues to support the American Running Association by serving on its Board of Directors. We wish her great success in her new endeavors. Good luck, Susan!

If medical scientists sometimes find it hard to recruit enough volunteers–especially Blacks–to participate in research studies, there may be a good reason, a new University of North Carolina at Chapel Hill study shows. A surprisingly high percentage of Americans surveyed–almost 80 percent of Blacks and 52 percent of Whites–were suspicious that they might be used as “guinea pigs” without their consent.

The first-of-its-kind study, conducted by a UNC School of Medicine investigator and colleagues, relied on data gathered in 1997 through a national telephone survey of 909 people sponsored by the Institute for Minority Health Research at Emory University. It showed that even after controlling for social and economic factors, Whites were not very trusting of doctors, and Blacks were even less so.

“Distrust has been proposed as one of the barriers to participation by minorities in research, but until now there haven’t been any studies to show how big that distrust might be or to substantiate racial differences,” says Dr. Giselle Corbie-Smith, assistant professor of social medicine and medicine at UNC. “For that reason, we tapped an existing database to see if there were differences by race and what might account for them.

“We found that in general, both Blacks and Whites distrusted medicine and medical research, but Blacks were significantly more likely to have high levels of distrust,” Corbie-Smith says. “Those differences didn’t go away when we controlled for factors that might influence them such as income and education.”

A report on the findings appeared in the Nov. 26 issue of the Archives of Internal Medicine, a journal published by the American Medical Association.

Specifically, Corbie-Smith and her colleagues found that 41.7 percent of Blacks and 23.4 percent of Whites did not trust their doctors to explain research participation fully. Almost 46 percent of Blacks and almost 35 percent of Whites felt their doctors exposed them to unnecessary risks when deciding on treatment.

Purpose: This study analyzed the number, type, and content of advance medical directives (AMD) presented by adult patients. Background/Significance: If an individual does have an AMD but it does not meet statutory requirements or is vague in describing the individual’s treatment preferences, complex issues can emerge when attempts are made to implement it. Methods: The AMD documents presented by patients admitted to critical care and medical-surgical units of a 600+ bed community teaching hospital over a 6-month period were reviewed by the investigator to determine type of document, compliance with statutory criteria, and specificity of content related to identification of advocate and treatment preferences. A data collection form was developed for the purpose of the investigation. Content validity was established by expert review. Results: Data revealed 14% of the patients reported having an AMD; however, only half reported bringing the document with them. The majority of documents (94%) met the statutory requirements for a patient advocate designation (durable power of attorney for healthcare). It was identified that 37% lacked information about how to contact the advocate, and 12% did not provide any clear treatment preferences. Coma, persistent vegetative state, and/or terminal illness were cited as criteria for limiting or withdrawing treatment in 86% of the documents that contained preferences. Approximately half of these also cited “quality of life” or “burdens” as additional criteria; however, personal values related to quality of life or burdens were not described. Conclusions: Although advance medical directives may meet statutory requirements, lack of information related to advocates, patient preferences, and/or personal values can limit the ability to interpret and apply the document. Increased efforts are needed to clarify the content of directives before emergencies occur and educate the community about the significance of clear, values-based directives.

Malaria kills more people each year than any other disease, but only 0.3 per cent of money alloted for medical research and development is spent on the sickness, a new report revealed.

The study of malaria research funding, published in the Independent, found “stark inequalities” between the amount of money spent on predominantly Western illnesses and diseases that kill millions every year in developing nations. The authors measured such disparities by comparing how many years of productive life are lost to a disease and the amount of money spent combating them. Although diabetes, for example, is three times less deadly than malaria, it gets six times more money in research and funding.

Like HIV/AIDS and TB, malaria is considered one of the major public health challenges in the world. According to Malaria Foundation International, more than 500 million people still suffer from the disease, while 2.5 billion people risk contracting it in 90 countries–particularly in developing nations. Children make up the vast majority of victims.

Microsoft boss Bill Gates recently promised $258 million in new grants to combat the disease through his charity, the Bill and Melinda Gates Foundation.

“It’s really a tragedy when the world has done so little to stop this disease that kills 2,000 African children every day,” Bill Gates told the Associated Press. “If those children were in rich countries, we would have headlines, we’d take action.”

A Coast Guard Maritime Security and Safety Team, acting on a tip from a law enforcement agency, stakes out the water around a nuclear power plant. Suddenly, the Integrated Anti-Swimmer System detects a swimmer stealthily approaching. When a verbal warning delivered by an underwater loudspeaker does not halt the diver’s progress, bursts of high-pressure air delivered through a submerged air gun create powerful low frequency impulses that cause disorientation and physical pain. The diver, startled and hurt, immediately surfaces and is captured, thus thwarting a planned terrorist attack.

Scientists from the Naval Submarine Medical Research Laboratory (NSMRL) were involved in the development and evaluation of these terrorist-thwarting devices. The lab provided many of the design parameters and performed much of the testing for the various components of the Integrated Anti-Swimmer System and the related Diver Interdiction System.

NSMRL’s Dr. Ed Cudahy has studied the human bioeffects of underwater sound for many years to protect our fleet and Special Operations Forces (SOF) divers. In the last three years, he has applied his vast knowledge to evaluating and validating various elements of potential non-lethal anti-swimmer systems for safety and tested the effectiveness of deterrent sounds for the Joint Non-Lethal Weapons Directorate, Coast Guard and Navy.

The impact of this work is enhancing our nation’s homeland defense and the protection of our nation’s military assets. These are just two examples of the myriad operational applications of the research conducted at this Navy Medicine laboratory, located a few hundred yards from the waterfront at Submarine Base New London, Groton, Conn. Why is NSMRL, whose mission is to protect the health and enhance the performance of our warfighters through focused submarine, diving and surface research solutions, on the frontlines of the global war on terrorism (GWOT)? One must look at our history for the answer.

A Proud History

In 1942, the Medical Research Section of the U.S. Submarine Base New London dispensary was tasked to provide “answers to problems in communications, vision, personnel selection, and environmental medicine which resulted from wartime demands on the submarine force.” Because of the critical importance of submarines during World War II, the lab’s work quickly expanded to include studies on night vision, color vision and lookout training.

A Brave New World

To the Editors of American Demographics:

I work for a company that sells umbilical cord blood and stem cell collection services. From the information we gathered, we believe there are approximately 4 million births a year. It would be very helpful in our marketing efforts to expectant mothers if we knew what percentage of these births were to women over the age of 30, and even more helpful if we could further break down this group by household income levels. Thank you for your consideration.

Dan Boerger

President

Advantage Direct Marketing

Berwyn, Pa.

Dear Dan:

Your inquiry could not have come at a more newsworthy time. In fact, it arrived just as President Bush was calling for more funding of scientific research using stem cells from sources other than human embryos, such as umbilical cord blood.

Now, to answer your question: In July, the Centers for Disease Control (CDC) released preliminary birth data for 2000, which confirms your figure for the number of new births. Indeed, last year there were 4.1 million births, about 106,000 more births than in 1999. Women ages 30 and older gave birth to 36.3 percent of the babies born in 2000, up slightly from 35.7 percent in 1999. Moreover, the CDC reports that in 2000, birth rates (the number of births per 1,000 women) for women ages 30 and older rose to their highest levels in 30 years. Currently, there are 94.2 births per 1,000 women age 30 to 34; 40.3 for women 35 to 39; 7.9 for women age 40 to 44; and 0.5 for women age 45 to 54.

For the income breakdown, we turned to the 2000 Current Population Survey’s (CPS) Fertility of American Women study. Of course, the numbers you desire are not available in a nice, easy-to-read report, so we got crunching. According to American Demographics’ analysis of CPS data on women ages 30 to 44 who gave birth in the past year, 10 percent came from families with an annual income of less than $15,000; 14 percent had incomes between $15,000 and $29,999; 19 percent earned between $30,000 and $49,999; and 23 percent took home between $50,000 and $74,999. The largest share of this population (34 percent) had a combined annual household income of $75,000 or more. That’s what you would call a “sugar mommy.”