Medicine: The A.M.A. & the U.S.A.

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Hard-won knowledge of the body's complex chemistry has developed the use of hormones such as ACTH and cortisone and their synthetic variants, and has led to life-saving control of a patient's sodium and potassium during severe illness and surgery. Thanks to new machines (see box), what once seemed impossible and then miraculous is now almost common place. And, notes U.C.L.A.'s Medical Dean Stafford Warren, "More medical research has been published since World War II than in all prior history."

A Lifter of Standards. In these recent developments, and even more notably in the formative years of U.S. medicine, the A.M.A. has played a promotional role. When 250 doctors from 22 states met in Philadelphia's Academy of Natural Sciences in 1847 to found the American Medical Association, both the need for it and its aims were clear. In the still raw frontier nation, most doctors were products of dubious diploma mills or outright quacks. The A.M.A. took on the job of raising the standards of medical education to the level of those in Europe, and of driving out the quacks. Success came slowly, but after the famed 1910 Flexner Report (for the Carnegie Foundation), the diploma mills were dramatically shut down. The fight against quackery still goes on; the A.M.A. has called a national conference on the problem, to be held in Washington, D.C., next October.

The A.M.A. was a leader in urging the compulsory registration of births and deaths, and saw this battle won everywhere by 1933. As early as 1874. the A.M.A. began to promote laws to prevent the spread of syphilis, and it was a prompt advocate of premarital examinations, which became general by 1937. Sample resolution in 1910: "The American Medical Association, through its House of Delegates, hereby presents for the instruction and protection of the lay public the unqualified declaration that illicit sexual intercourse is not only unnecessary to health, but that its direct consequences in terms of infectious disease constitute a grave menace to the physical integrity of the individual and of the nation."

Still pursued with vigor is the crackdown on quack remedies, now under the Department of Investigation. This office does original investigations, cooperates with federal watchdog agencies, and often provides the evidence to get convictions.

Great Mouthpiece. It was this department, says the association itself, "that gave the A.M.A. stature with the public." But A.M.A.'s best remembered stature giver was a rasp-voiced, acid-penned doctor named Morris Fishbein, who became editor of the A.M.A. Journal in 1924.* Editor Fishbein had opinions on everything even remotely medical and expressed them unhesitatingly, often without a by-your-leave to A.M.A.'s top officers and trustees. He crusaded against anything "socialistic," by which he meant virtually any proposal to alter medical practice or payment procedures.

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