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Exploring Human Potential

My Fictional Day At The Beach With Lindsey Graham.

Posted on | August 15, 2022 | 2 Comments

Mike Magee

Senator Lindsey Graham (R.,S.C.) is on summer recess. A consummate professional politician, and war hardened lawyer, Sen. Graham has made a career out of flipping on a dime. His moral calculus has been flexible enough to wiggle and weave, and switch sides if cornered. 

In my dreams, I caught a glimpse of him reading on one of his state’s beautiful beaches. He was juggling a weighty 1215 page classic – Leo Tolstoy’s “War & Peace” in one hand, and a yellow highlight marker in the other.

He looked a bit on edge, maybe because this week a federal judge refused to block a subpoena seeking his testimony for a Fulton County, Georgia, Grand Jury probe into efforts by then-President Donald Trump and his potential state Republican “alternate electors” to overturn Georgia’s Biden victory in the 2020 election.

When he hit the water to cool off, his book was just sitting there on a Polo beach blanket.  I couldn’t help but notice the MAGA bookmark – it’s was on page 1133 with these words highlighted: 

“Chance made the situation; genius profited from it…”, and Lindsey’s scribbled notation “IMPORTANT.”

Judging from the heavy highlighting, it seemed Lindsey had been carefully rereading a tattered personal copy, and OCD’ed on Tolstoy’s Epilogue, pages 1131 to 1136.

Lindsey was obviously looking for some insight how to manage his current predicament in Tolstoy’s literary undressing of Napoleon.

Right there on page 1133, he had scrawled across the top “WOW.” 

The second and third paragraph seemed to have resonated because there was a yellow line along the left margin:

“…the old insufficiently large group is destroyed; old customs and traditions are obliterated; step by step a group of a new size is produced, along with new customs and traditions, and that man is prepared who is to stand at the head of the future movement and bear upon himself all the responsibility for what is to be performed…A man without conviction, without customs, without traditions, without a name, not even a (military man or politician), seemingly by the strangest chances, moves among all the parties stirring up (hatreds), and, without attaching himself to any of them, is borne up to a conspicuous place.”

The fourth paragraph was floating in a yellow bath, and in the margin a text box with arrow read, “This hurts!”

“The ignorance of his associates, the weakness and insignificance of his opponents, the sincerity of his lies, and the brilliant and self-confident limitedness of this man moved him to the head…the reluctance of his adversaries to fight his childish boldness and self-confidence win him…glory…The disgrace he falls into…turns to his advantage. His attempts to change the path he is destined for fail…Several times he is on the brink of destruction and is saved each time in an unexpected way…the very ones who can destroy his glory, do not, for various diplomatic considerations…”

Turning the page, there was a scribble on page 1134 next to the 1st new paragraph, “TS/SCI/ Mar-a-Lago.”  And on the other margin, “Soooo True!”:

“The ideal of glory and greatness which consists not only in considering that nothing that one does is bad, but in being proud of one’s every crime, ascribing some incomprehensible supernatural meaning to it – that ideal which is to guide this man and the people connected with him, is freely developed…His childishly imprudent, groundless and ignoble (actions)…leave his comrades in trouble…”

In the middle of the same page, again in Lindsey’s hand, “NO PLAN”:

“He has no plan at all; he is afraid of everything…He alone, with his ideal of glory and greatness…with his insane self-adoration, with his boldness in crime, with his sincerity in lying – he alone can justify what is to be performed…”

And on adjoining page 1135, across the top, “HE’S GOING DOWN.”

with a highlighted last paragraph that read:

“But suddenly, instead of the chances and genius that up to now have led him so consistently through an unbroken series of successes to the appointed role, there appear a countless number of reverse chances….and instead of genius there appears an unexampled stupidity and baseness…”

As I began to stir, Lindsey was heading my way. Just time for one more page flip. Page 1136 and 1137.

“…all his actions are obviously pathetic and vile…deprived of strength and power, exposed in his villainies and perfidies…not only does no one arrest him, but everyone greets with rapture the man they cursed the day before and will curse a month later. This man is needed to justify the last joint act. The act is performed. The last role has been played. The actor is told to undress and wash off his greasepaint and rouge; there is no more need for him…The stage manager, having finished the drama and undressed the actor shows him to us. ‘Look at what you believed in! Here he is! Do you see now that it was not he but I who moved you?’”

Lindsey’s smeared notation in permanent black marker,

“MY NEXT MOVE.”

Monday in America – Message on Positive Leadership from Karen Katen.

Posted on | August 8, 2022 | No Comments

Mike Magee

With President Biden’s positive leadership at home and abroad, our nation this Monday morning in August, appears to be turning the corner.

While clearly not out of the woods yet, we Americans and our form of government has withstood a serious stress test, one led by a rogue leader and a party (unlike the former Watergate crisis) that for some reason decided to follow this false Messiah rather than muster the strength to resist and do their duty.

The damages, including an assault on women rights and their autonomy over their own bodies, will need to be undone. But steps like this weekend’s passage of “Inflation Reduction Act” and last week’s Kansas 59% vote to say “no” to radical abortion legislation provide more than a glimmer of hope.

The battle between positive and negative leadership is not a new phenomenon, though seldom have we seen it in such sharp relief. I have studied and published on this very topic for over four decades. My 1995 publication, POSITIVE LEADERSHIP, contains 10 cornerstone themes, and 52 personal challenges, which appear to “hold up” in my re-read early this morning.

About this book, my friend, Karen Katen, President of U.S. Pharmaceuticals for Pfizer Inc., wrote in 1999: 

“Truly effective leadership requires more than a commitment to performance—it also requires a positive attitude and a healthy, balanced perspective on life. This is the power of Dr. Mike Magee’s Positive Leadership. Transcending religions and philosophies, Mike has crafted a work of immutable, undeniable positive truths about life and how ones life ought to be lived.

While warmly told from the author’s own experience, the actual voice is eerily familiar. It is nothing less than the reader’s own inner voice, all too often lost in the din of our modern times. In other words, Mike’s simple lessons are ones we know to be right and true, and have always known to be right and true—we may have just forgotten or misplaced them.

With its compelling clarity, Mike’s work is more than just a useful reminder. It serves as a practical solution for those individuals and organizations that are experiencing a disconnect between their actions and their values.

Its timeless themes make Positive Leadership nothing less than a moral survival manual. No home or office should be without it.”

In these words, Karen encapsulated the challenge we, as Americans, face now 23 years later. We have encountered and partially confronted as a nation:

  1. Lessons “forgotten or misplaced.”
  2. A “disconnect between actions and values.”
  3. And “our own inner voice” or “moral survival manual” to guide us back home.

Karen’s message for America is hopeful, practical and doable. It has also never been more important than on this Monday in America.

__________________________________________________________________

If you would like to read POSITIVE LEADERSHIP, it is available free online HERE. If you would prefer a hard copy, it is available on Amazon HERE.

 

“Revolving Door” Doesn’t Quite Describe It. It’s Lou Lasagna’s “Integrated Career Ladder.”

Posted on | July 28, 2022 | 2 Comments

Mike Magee

Last week, the New York Times shinned a light on the FDA’s top science regulator of the tobacco industry, Matt Holman, who announced his retirement after 20 years to join Phillip Morris. As they noted, “To critics, Dr. Holman’s move is a particularly concerning example of the ‘revolving door’ between federal officials and the industries they regulate…”

As a Medical Historian, I’ve never been a fan of the casual “revolving door” metaphor because it doesn’t quite capture the highly structured and deliberate attempts of a variety of academic medical scientists over a number of decades in the 2nd half of the 20th century to establish and reward an “integrated career ladder” that connected academic medicine, industry and the government. 

As I noted this week, Harvard’s Dr. Henry K. Beecher, raised a red flag in 1966 in a NEJM article, “Ethics and Clinical Research”, where he wrote, “Medical schools and university hospitals are increasingly dominated by investigators. Every young man knows that he will never be promoted to a tenure post, to a professorship in a major medical school, unless he has proved himself as an investigator. If the ready availability of money for conducting research is added to this fact, one can see how great the pressures are on ambitious young physicians.”

In CODE BLUE: The Birth of the Medical-Industrial Complex, I recount the vertical integration strategies of deception that were Arthur Sackler. But the role model for the “young physicians” of his day was not Sackler, but rather the physician and pharmacologist Louis Lasagna who had trained at Johns Hopkins. In 1956, he lobbied the FDA to develop a separate metric beyond “safety” to assess the effectiveness of new drugs coming to market. 

As a contrarian, he was an equal-opportunity offender, often sought after for media commentary. He had challenged the pharmaceutical industry’s over-the-top marketing claims, outrageous prices, and deceptive relationships with doctors nationwide in the 1950’s, but also was not shy about criticizing his fellow physicians’ dismal state of expertise in all things pharmacologic.

In 1962, Lasagna’s knowledge and outspokenness led to an invitation to join the government team evaluating FDA policy. When he appeared before Estes Kefauver’s congressional committee, he made headlines in Arthur Sackler’s hometown by lamenting the fact that money was corrupting doctors’ professional decision-making choices, or as he put it, “Madison Avenue” had discovered “Medicine Avenue.” He also labeled the science involving the “equivalency” of generic products “abysmally ignorant” and the standards for quality “inadequate.” 

The committee to which Lasagna said all these things went on to craft the Kefauver-Harris Amendment, or the Drug Efficacy Amendment, to the Federal Food, Drug, and Cosmetic Act. Adopted in 1962, the amendment introduced a requirement for drug manufacturers to provide proof of the effectiveness and safety of their drugs before approval, required drug advertising to disclose accurate information about side effects, and prevented cheap generic drugs from being marketed under new trade names as “breakthrough” medications.These requirements were retroactive, meaning that more than 4,000 drugs that had appeared on the market between 1938 and 1962 needed to be critically evaluated. 

To determine these drugs’ effectiveness, the government created the Drug Efficacy Study (DES), which involved multiple panels of experts drawn from the National Academy of Science and the National Research Council. The lead voice on the DES was the outspoken Louis Lasagna. He had acknowledged industry support of his fellowship programs in clinical pharmacology at Johns Hopkins, and, with the support of the American Enterprise Institute, he had endorsed collaboration between “universities and the pharmaceutical industry . . . to join forces in providing reasonable advice to government . . . to prevent unwise participation of the government in drug development.” If Lasagna occasionally slammed the drug industry as well, that was just Lou being Lou. 

Not shy in promoting himself or his ideas, Lasagna had a knack for deleting embarrassing details from his ever-expanding professional narrative. Few knew that he had unsuccessfully pressured the FDA to approve thalidomide on behalf of its US manufacturer, RichardsonMerrell. Fewer still remembered his publicly quoted remark following the barbiturate-overdose death of Marilyn Monroe in 1962: “If Marilyn Monroe’s physician had been able to prescribe that drug (thalidomide) instead of barbiturates she might still be alive.” 

In the early years following the thalidomide disaster, the American people and their government were willing to accept the new rules and the delays in drug development they fostered. However, they became less tolerant a decade later when a deep recession, accompanied by high interest rates and extraordinarily thin pipelines for new discoveries, stubbornly resisted corrective steps.

Lasagna was all about free enterprise and eliminating what he viewed as excessive government regulation. That worldview was well capsulized in remarks he made in 1976. Quoting Rochester Chancellor Wallis, Lasagna said, “‘The remedy . . . is obvious and simple, but implausible. Return the power to the people.” In 1970, Lasagna became chairman of the Department of Pharmacology and Toxicology at the University of Rochester’s School of Medicine, where he founded the Center for the Study of Drug Development (CSDD), a common meeting ground for free market–minded academics, government, and corporate leaders. By 1976, he had moved his center to Boston’s Tufts University. He was now a renegade scholar, a successful entrepreneur, and a lightning rod for controversy. But within the business community, he was a much-sought-after speaker, much like California’s Ronald Reagan had become. 

From the start, Lasagna’s CSDD was a multifaceted and highly productive platform, providing professional development courses in clinical pharmacology, drug development, research processes, and pharmaceutical regulations. It generated influential white papers and reports on everything from clinical research design to the growing trend of outsourcing work to contract (or clinical) research organizations (CROs). It also provided customized reports helping individual clients design their government-relations strategies in pursuit of favorable policies. 

Throughout the 1970s, the pharmaceutical-industry-funded CSDD under Lasagna laid the statistical groundwork to “prove” that the pharmaceutical industry was “high risk/high gain,” that government-induced delays eroded patent life and profitability, and that inadequate protection of intellectual property rights discouraged investment, discovery, and innovation. New drug launches in the US had dropped to around 40 per year, and for nearly all of these, the drug’s appearance in Europe preceded its US debut by approximately two years. Lou labeled the delay a “drug lag,” and pegged the cost of bringing a new drug to market at $800 million and the losses associated with a one-month delay in a product review by the FDA at $10 million for the sponsoring company.

When Reagan came to power in 1980, it was Lasagna who led the way in wholesale deregulation of the Medical-Industrial Complex including special channels for rapid drug approval and forfeiture of NIH patents (Bayh-Dole Act) that financially super-charged the “integrated career path” as a scaffolding for the MIC for the following four decades.

The Core Problem That Led To Tuskegee Has Never Been Addressed.

Posted on | July 26, 2022 | 4 Comments

Mike Magee

Today is the date that all AP Science journalists know by heart. As the AP banner headline broadcast this morning: “On July 25, 1972, Jean Heller, a reporter on The Associated Press investigative team, then called the Special Assignment Team, broke news that rocked the nation. Based on documents leaked by Peter Buxtun, a whistleblower at the U.S. Public Health Service, the then 29-year-old journalist and the only woman on the team, reported that the federal government let hundreds of Black men in rural Alabama go untreated for syphilis for 40 years in order to study the impact of the disease on the human body. Most of the men were denied access to penicillin, even when it became widely available as a cure. A public outcry ensued, and nearly four months later, the “Tuskegee Study of Untreated Syphilis in the Negro Male” came to an end.”

Eight years earlier, a young physician from Detroit, Irwin Schatz, came across a study in a medical journal titled “The Tuskegee Study of Untreated Syphilis: 30 Years of Observation.” Incredulous, he shot off a letter to the editor: “I am utterly astounded by the fact that physicians allow patients with a potentially fatal disease to remain untreated when effective therapy is available.” It was later revealed that Dr. Schatz’s message was read by Anne R. Yobs, one of the US Public Health Service employees who designed the Tuskegee Study, and who wrote to her superior, “This is the first letter of this type we have received. I do not plan to answer this letter.” 

On June 16, 1966, the New England Journal of Medicine published an article titled “Ethics and Clinical Research.” Written by a highly respected Harvard physician, Henry K. Beecher, the head of anesthesiology at Massachusetts General Hospital, the article referred to “troubling charges” that had grown out of “troubling practices” at “leading medical schools, university hospitals, private hospitals, governmental military departments (the Army, the Navy and the Air Force), governmental institutes (the National Institutes of Health), Veterans Administration hospitals and industry.”

“Since World War II,” Beecher continued, “the annual expenditure for research . . . in the Massachusetts General Hospital has increased a remarkable 17-fold. At the National Institutes of Health, the increase has been a gigantic 624-fold. This ‘national’ rate of increase is over 36 times that of the Massachusetts General Hospital. . . . Taking into account the sound and increasing emphasis of recent years that experimentation in man must precede general application of new procedures in therapy, plus the great sums of money available, there is reason to fear that these requirements and these resources may be greater than the supply of responsible investigators. All this heightens the problems under discussion. . . . Medical schools and university hospitals are increasingly dominated by investigators. Every young man knows that he will never be promoted to a tenure post, to a professorship in a major medical school, unless he has proved himself as an investigator. If the ready availability of money for conducting research is added to this fact, one can see how great the pressures are on ambitious young physicians.”

After Irwin Schatz first raised the issue, the AMA still endorsed continuation of the Tuskegee  study. Not until 1972, when the glare of publicity reached what was known as the “Tuskegee Experiment,” was the study finally shut down. It led to a $10 million out-of-court settlement to cover the lifetime health needs and burial expenses of participants. 

Tuskegee also led to the 1974 National Research Act, which finally incorporated some of the protections recommended at the Nuremberg Trials. Voluntary consent was now required for all participants in US medical research funded by federal dollars. A study’s design had to be reviewed and pre-approved on ethical grounds by an institutional review board, a body of local professionals who would critique each proposed study and attest that it met ethical standards. Finally, the act established the National Commission for the Protection of Human Subjects of Biomedical Research, which was charged with identifying “the basic ethical principles which should underlie the conduct of biomedical and behavioral research involving human subjects.”

Even so, the official apology for the violations of the Nuremberg Code (also known as crimes against humanity) at Tuskegee would have to wait another quarter century, when President Bill Clinton at last acknowledged, “The United States government did something that was wrong—deeply, profoundly, morally wrong.” 

But in the spirit of  “Gone, but not forgotten”, I recommend for tonight’s summer viewing “The Dropout” streaming on Hulu. It documents the felonious activities of Elizabeth Holmes and her disgraced biotechnology company Theranos. 

Why? Because Dr. Beecher had it right. While the various different patient protections provide some improvement at the margins, the core of the problem (as I lay out in CODE BLUE: Inside The Medical-Industrial Complex), is a profit seeking Medical-Industrial Complex built on an integrated career ladder (Academic Medicine to Industry to Government), and absent appropriate checks and balances. What can be done about it? See page 315-324 in CODE BLUE for my suggestions.

The Constitutional Right to Health Care: An Historical Perspective in 5 Parts.

Posted on | July 19, 2022 | Comments Off on The Constitutional Right to Health Care: An Historical Perspective in 5 Parts.

Mike Magee

Several weeks ago, I raised a red flag that assaults on women’s right to control their own health decisions threatened their autonomy, as well as the professional rights of physicians.

Last week, I suggested that recent changes at the interface of economics and education in the American electorate had created a “polarity reversal” in swing voters. This created on the one hand, an extremist climate that over-turned Roe v. Wade, and on the other hand expanded the possibility that Medicare for All (M4A) might become a reality in the future.

Health care and human rights are inseparable. In this follow-up 5-part series, I review the Constitutional basis for claiming the “right to health care” for all American citizens in an effort to provide much needed historical context to guide future debate.

Part I: The Argument – Who Controls Your Rights?

Part II: Common Sense vs. Power Plays: “Let the end be legitimate.”

Part III: The Right to Privacy and Health.

Part IV. The Need for Reform: “Necessitous men are not free men.”

Part V. Addressing “The Tyranny of the Minority.” M4A- an entry point.

Why “Medicare for All” Could Appeal to White Swing Voters.

Posted on | July 12, 2022 | Comments Off on Why “Medicare for All” Could Appeal to White Swing Voters.

Mike Magee

“There’s common ground there—not the warm belonging of full creedal agreement, perhaps, but a place, even a welcoming place, where we can stand together.”    Ian Marcus Corbin, Research Fellow, Harvard Medical School

Most Americans would love to believe this statement. But political reality intervenes. A March, 2022 Pew Research Center analysis found our two major parties to be “farther apart ideologically today than at any time in the past 50 years.” 

Take, for example, Presidential hopefuls, Florida Gov. Ron DeSantis and Sen. Marco Rubio (R-Fla.). They see political pay dirt on the jagged peaks of America’s culture wars with the governor taking on Disney for defending LGBTQ employees by introducing the his “Stop W.O.K.E. Act, while Rubio goes one step further with his “No Tax Breaks for Radical Corporate Activism Act”.

In academic circles, you increasingly find references to “what’s the matter with…debates.” The phrase derives from a 2004 book “What’s the Matter with Kansas?”  written by historian Thomas Frank, which spent 18 weeks on the New York Times Bestseller List. 

In the book, Frank detailed the transformation of Kansas from a “hotbed of left-wing populism” to a center of “anti-elitist conservatism in the United States” and exposed the state’s remarkable capacity to vote against its own economic self-interests. 

The title itself originated in an August 15, 1896 editorial in the the Kansas Emporia Gazette. It was written by a political leader, William Allen White, who charged that the state’s slippage into economic stagnation (compared to neighboring states) was the result of overly aggressive progressive policies which unduly restricted small business. William McKinley, in his 1896 run for the Presidency, picked up on the theme, distributing hundreds of thousands of copies of the editorial as part of his campaign.

In modern times, selected academics argue that working-class social conservatives have abandoned the Democratic New Deal political coalition and landed on the rocky knolls of Republican shores mired in conservative ideology and buffeted by religion laced cultural gale-force winds.

Others, like Vanderbilt political scientist Larry Bartels, challenged these assumptions. As he summarized in 2005: “Has the white working class abandoned the Democratic Party? No. White voters in the bottom third of the income distribution have actually become more reliably Democratic in presidential elections over the past half-century, while middle- and upper-income white voters have trended Republican.”

A recent publication by two political scientists – Herbert P. Kitschelt from Duke and Philipp Rehm from Ohio State – says no one should be surprised by what happened in 2016, because it was a long time in the making. 

What makes white Americans vote the way they do, they say, lies at the cross-roads of economics and education. Using a four quadrant analysis graph, they tracked white voters presidential preferences from 1952 to 2016 in four groups – I. Low Education/Low Income, II. Low Education/High Income, III. High Education/Low Income, IV. High Education/High Income.

Primary Source

Using a version of this graph, they concluded that that there has been a “polarity reversal…the New Deal core constituencies of the two main US parties—low-education/low-income voters for the Democrats and high-education/high-income voters for the Republicans—have become swing groups; the former swing groups are the parties’ new core constituencies (high-education/low-income voters for the Democrats and low-education/high-income voters for the Republicans).”

Specifically they believe that:

  1. The Democratic Party is being abandoned by lower education/higher income white voters. (Think small business men/local Chambers of Commerce), while higher education/higher income are slowly moving to neutral “swing” status.
  2. Lower income workers are also segregating based on education. Those white voters with little income or education are moving away from Democrats to neutrality – “drifting into right-wing politics” and exploring militarizing “social governance, racism and xenophobia.” In contrast, low income, high education whites are securely now in Democratic territory.

What does all this mean? It appears that, as we have transformed from an industrial society to a knowledge society, the traditional New Deal core groups (Dem- LE/LI; Rep- HE/HI) that anchored the two parties have become swing groups filled with divided, volatile “independents” up for grabs.

How do you reach these new swing voters? Is there anything programmatic that might enjoy the support of large numbers of swing voters? 

How about those Big Education/High Income individuals. In 2020, 68% of the S&P 1500 CEO’s were Republicans in a National Bureau of Economic Research study. What might the government offer the workers that labor in their charge?

How about those Low Education/Low Income individuals. Many manage to rise to intermediate incomes, only to fall back when faced with predatory debt often associated with a family illness or tragedy.

Programmatic solutions that would unite us need to appeal on multiple levels to members of swing quadrants. One concrete example would be “Medicare for All.” It would free the HE/HI CEO’s of managing employee health care while trying to run their companies. It would also assist LE/LI strivers by reinforcing health and productivity, avoiding crippling medical debt, and creating new job opportunities.

So, in fact, as Dr. Corbin suggests, “There’s common ground…a welcoming place, where we can stand together.” Programs and services that create jobs, reinforce community linkages, and equitably promote compassion, understanding and opportunity are political pay dirt. Democrats and Republicans would help themselves, and help America, by seeking “common ground” under the banner of  “Medicare-for-All.”

Mike Magee’s Advice To The AMA On Reversal of Roe v. Wade.

Posted on | June 27, 2022 | 10 Comments

Mike Magee

Stable, civic societies are built upon human trust and confidence. If you were forced to rebuild a society, leveled by warfare and devastation, where would you begin? This is the question the U.S. Army faced at the close of WW II, specifically when it came to rebuilding Germany and Japan, hopefully into stable democracies. The Marshall Plan answered the question above, and its success in choosing health services as a starting point was well documented by many in the years to come, including the RAND Corporation. Their summary in 2007 said in part, “Nation-building efforts cannot be successful unless adequate attention is paid to the health of the population.” 

They began with services for women and children, the very location that a splinter of politicians and Supreme Court Justices has targeted, replacing entrusted doctors with partisan bureaucrats in an approach so obviously flawed that it forced a course correction a half century ago in the form of Roe v. Wade.

The practice of Medicine is complex. Ideally it requires knowledge, skills, supportive infrastructure, proximity and presence. But most of all, it requires trust, especially in moments of urgency, with lives at stake, when an individual, and family, and community are all on high alert. When time is of the essence, and especially if one or more people are trying to make the right decision for two, rather than one life, decisions are impossibly personal and complex.

This was widely recognized by most physicians, including those most devout and conservative nationwide in the troubling years leading up to Roe v. Wade. As recently as 1968, the membership of the Christian Medical Society refused to endorse a proclamation that labeled abortion as sinful.  In 1971, America’s leading conservative religious organization, the Southern Baptist Convention, went on record as encouraging its members “to work for legislation that would allow the possibility of abortion under such conditions as rape, incest, clear evidence of severe fetal deformity, and carefully ascertained evidence of the likelihood of damage to the emotional, mental, and physical health of the mother.” In 1973, both the Southern Baptist Convention and the Christian Medical Society chose not to actively oppose the Supreme Court ruling against a Texas law prohibiting abortion known as Roe v. Wade, and reaffirmed that position in 1974 and 1976.

What they recognized was that the nation’s social capital, its political stability and security, relied heavily on the compassion, understanding and partnership engendered in the patient-physician relationship. As most doctors saw it, what possible good could come from putting politicians in the middle of such complicated, emotion-ridden, and highly personal decisions?

The American Medical Association’s prepared reaction to the June 24, 2022, reversal to Roe v. Wade was direct and immediate. They labeled the decision “an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient-physician relationship…” Their president, Jack Resneck Jr. M.D. went further to say, “…the AMA condemns the high court’s interpretation in this case. We will always have physicians’ backs and defend the practice of medicine, we will fight to protect the patient-physician relationship..” But what exactly does that mean?

Approaching 75, and a lifelong member of the American Medical Association, I expect I know the AMA, its history as well as its strengths and weaknesses, about as well as anyone. Aside from having deep personal relationships with many of the Board of Trustees over the years (some of whom quietly continue to contact me for advice), I have studied the evolution of the patient-physician relationship in six countries over a span of forty years.

Those who know me well, and who have pushed back against my critique of the organization, know that my intentions are honorable, and that the alarms that I sound reflect my belief that, for our profession to survive as noble, self-governing, and committed above all to the patients who allow us to care for them, we must have a national organization with reach into every American town and city, and official representation in every state, and every specialty.

My concern today, despite the strong messaging from Chicago, is that the AMA and its membership have not fully absorbed that this is a “mission-critical” moment in the organization’s history. It is also an opportunity to purposefully flex its muscles, expand its membership, and reinforce its priorities. The strong words, without actions to back them up, I believe, will permanently seal the AMA’s fate, and challenge Medicine’s status as a “profession.”

Here are five actions that I believe the AMA should take immediately to make it clear that physicians stand united with our patients, in partnership with nurses and other health professionals, and that the actions of last week can not and will not stand.

  1. The AMA should pull all financial support for all Republican candidates through the 2022 elections.
  2. The AMA should actively encourage physician “civil disobedience” where appropriate to protect the health and well being of all women, regardless of age, race, sexual identity, religion, or economic status.
  3. The AMA should convene, under the auspices of its’ General Counsel, Andra K. Heller, a formal strategy meeting with the legal counsels of all state and specialty medical societies to formulate an aggressive legal approach to minimize the damage of the recent Supreme Court action.
  4. The AMA should actively promote AMA volunteers to help provide a full range of women’s health care services at federal institutions and on federal land, and stand up information sites that coordinate travel and expenses should inter-state travel be required for care access.
  5. The AMA should immediately make clear that any restriction of prescribing authority of medications in support of women’s health care, including contraceptive medications and devices, and Plan B treatments will result in a coordinated nationwide disruption of health services.
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