How the American Medical Association Got Rich

The following is an excerpt from "The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy" (Berkeley: North Atlantic Books, 2007) by Dana Ullman, MPH.

History reveals that the AMA was dictatorially led for the first half of the twentieth century by George H. Simmons, MD (1852-1937) and his protégé, Morris Fishbein, MD (1889-1976). Simmons and Fishbein both served as general manager of the organization and as editor of its journal, the Journal of the American Medical Association (JAMA). While these two leaders provided substantial benefit to the organization and to medical doctors, their methods of doing so have been severely criticized, with some historians referring to them as "medical Mussolinis."

When George H. Simmons began in 1899 what became a twenty-five-year reign as head of the AMA, it was a weak organization with little money and little respect from the general public. The advertising revenue from the medical journal was a paltry $34,000 per year. Simmons came up with the idea to transform the AMA into a big business by granting the AMA's "seal of approval" to certain drug companies that placed large and frequent ads in JAMA and its various affiliate publications. By 1903, advertising revenue increased substantially, to $89,000, and by 1909, JAMA was making $150,000 per year. In 1900, the AMA had only 8,000 members, but by 1910, it had more than 70,000. This substantial increase in advertising revenue and membership was not the result of new effective medical treatments, for there were virtually no medical treatments from this era that were effective enough to be used by doctors today or even just a couple of decades later.

Some critics of the AMA have called their seal-of-approval program a form of extortion because the AMA did no testing of any products. When George Abbott, owner of a large drug company, Abbott Biologicals (known today as Abbott Laboratories), did not provide "blackmail" money to the AMA and when none of his products were granted AMA approval, Abbott went on the offensive. He arranged for an investigation of the AMA president that revealed that Simmons had no credible medical credentials, that he worked primarily as an abortion doctor for many years, and that he had had sex charges brought by some of his patients as well as charges of negligence in the deaths of others. After this meeting, the drugs made by Abbott Laboratories were regularly approved, and the company was not required to place any ads.

Simmons was shrewd enough to have the AMA establish a Council on Medical Education in 1904. This council's mission was to upgrade medical education -- a worthy goal. The formation of the council seemed a good idea to homeopaths because surveys in JAMA itself had consistently shown that the graduates of the conventional medical schools failed the medical board examinations at almost twice the rate of graduates of homeopathic colleges. However, the AMA developed guidelines to give lower ratings to homeopathic colleges. For instance, just having the word "homeopathic" in the name of a school had an effect on the rating because the AMA asserted that such schools taught "an exclusive dogma."

In 1910, the same year that the Flexner report was published, the AMA published "Essentials of an Acceptable Medical College", which echoed similar criteria for medical education and a disdain for non-conventional medical study. In fact, the AMA's head of the Council on Medical Education traveled with Abraham Flexner as they evaluated medical schools. The medical sociologist Paul Starr wrote in his Pulitzer Prize-winning book: "The AMA Council became a national accrediting agency for medical schools, as an increasing number of states adopted its judgments of unacceptable institutions." Further, he noted: "Even though no legislative body ever set up ... the AMA Council on Medical Education, their decisions came to have the force of law". With the AMA grading the various medical colleges, it became predictable that the homeopathic colleges, even the large and respected ones, would eventually be forced to stop teaching homeopathy or die.

In 1913, Simmons and the AMA went on the offensive even more strongly by their establishment of the "Propaganda Department," which was specifically dedicated to attacking any and all unconventional medical treatments and anyone (MD or not) who practiced them. In this same year, Simmons hired Morris Fishbein, MD, as a publicity man for the AMA.

In 1924, Simmons was forced out of the AMA due to the many scandals around him, and he took home all his personal files and burned them, though Simmons was again wise enough to have trained his replacement, Morris Fishbein. Fishbein's specialty was publicity and the media, and he used the media to attack anyone who provided a real or perceived threat to conventional medicine. Besides severe attacks against anyone who practiced unconventional medical treatments, Fishbein and the AMA were also initially extremely antagonistic to those conventional medical doctors who supported pre-paid health insurance.

Fishbein was a medical doctor who never practiced medicine. He was, however, an effective advocate for conventional medicine and a vocal critic of unconventional treatments. Shortly after he became head of the AMA, he wrote several books sharply critical of "medical quackery." He called chiropractic a "malignant tumor," and he considered osteopathy and homeopathy "cults." While Fishbein certainly provided benefit to the general public by warning them about some of the medical chicanery that existed at the time, he lumped together everything that was not taught in conventional medical schools and considered all such modalities quackery. When one considers that the vast majority of medicine practiced in that era was inadequately tested and dangerous to varying degrees, Fishbein's obsessive fight against certain treatments provided direct benefits to the physicians he was representing.

Fishbein's frequent and strident attacks on "health fraud" were broadcast far and wide, in part through his own newspaper column, syndicated to more than 200 newspapers, as well as a weekly radio program heard by millions of Americans. His influence on medicine and medical education was significant, and it is surprising how few medical history books mention his influence or his questionable tactics. Time magazine referred to him as "the nation's most ubiquitous, the most widely maligned, and perhaps most influential medico."

There are also numerous stories about Fishbein's efforts to purchase the rights to various healing treatments, and whenever the owner refused to sell such rights, Fishbein would label the treatment as quackery. If the owner of the treatment or device was a doctor, this doctor would be attacked by Fishbein in his writings and placed on the AMA's quackery list. And if the owner of the treatment or device was not a doctor, it was common for him to be arrested for practicing medicine without a license or have the product confiscated by the Food and Drug Administration (FDA) or the Federal Trade Commission (FTC). Although Fishbein denied these allegations, he and the AMA were tried and convicted of anti-trust violations for conspiracy and restraint of trade in 1937. Further, Fishbein wrote numerous consumer health guides, and his choice of inclusion for what works or what doesn't work was not based on scientific evidence.

Fishbein extended Simmons's idea for the AMA seal of approval to foods, and by including a significant amount of advertising from food and tobacco companies, he was able to make the AMA and himself exceedingly rich. In fact, under his reign, the tobacco companies became the largest advertiser in JAMA and in various local medical society publications. In fact, Fishbein was instrumental in helping the tobacco companies conduct acceptable "scientific" testing to substantiate their claims. Some of the ad claims that Fishbein approved for inclusion in JAMA were: "Not a cough in a carload" (for Old Gold cigarettes), "Not one single case of throat irritation due to smoking Camels," "More doctors smoke Camels than any other cigarette," "Just what the doctor ordered" (L&M cigarettes), and "For digestion's sake, smoke Camels" (because the magical Camel cigarettes would "stimulate the flow of digestive fluids").

By 1950, the AMA's advertising revenue exceeded $9 million, thanks in great part to the tobacco companies.

Coincidentally, shortly after Fishbein was forced out of his position in the AMA in 1950, JAMA published research results for the first time about the harmfulness of tobacco. Medical student Ernst Wynder and surgeon Evarts Graham of Washington University in St. Louis found that 96.5 percent of lung cancer patients in their hospitals had been smokers. Very shortly after the AMA withdrew its seal of approval for Morris Fishbein, he became a high-paid consultant to one of the large tobacco companies.