Get Out of Our Exam Rooms: A Brief History of the Uneasy Relationship between Medicine and Politics
So far, 2012 has seen state legislators proposing an unprecedented number of bills aimed at regulating women’s access to various reproductive health services, including mammograms, annual pap smears to detect cervical cancer, contraceptives, and abortion, as well as women’s ability to pay for these services through private and public insurance providers. The underlying assumption in all of this health legislation is that women are unable to make informed, responsible decisions about their bodies unless they are mandated to do so by the state. A parallel implication is that even the physicians treating these women are incapable of making medically appropriate decisions without state interference. Medical professionals finally began fighting back on this political trespassing on their terrain just this week. In a letter to the editor of The New York Times, James T. Breeden, President of the American Congress of Obstetricians and Gynecologists, wrote, “Politicians were not elected to, nor should they, legislate the practice of medicine or dictate the parameters of the doctor-patient relationship. Our message to politicians is unequivocal: Get out of our exam rooms.”
While some folks might find it surprising that the medical profession would enter into this political morass, in fact, doctors have a long history of political activism. When the American Medical Association organized in 1847, it did so with the aim of standardizing medical education, training, and practice in the United States. They also wanted to eliminate their “irregular” competitors—such as homeopaths, osteopaths, and midwives, as well as the itinerant quacks selling flavored water as a cure-all. Among the first political measures for which the AMA lobbied was the criminalization of abortion. A century later, faced with high rates of women presenting in emergency rooms dying from botched illegal and often self-induced abortions (an estimated 5,000 women died each year; that is 13 or 14 women every day), physicians began lobbying states to decriminalize abortion.
Abortion was not the only issue that brought doctors into the political realm. The AMA and other specialty organizations also lobbied to expand and defend their ability to provide healthcare to Americans. In 1906, for example, the AMA advocated for the passage of the Food and Drugs Act, which prohibited unlicensed practitioners from dispensing unregulated drugs. Throughout the 1920s and 1930s, the AMA successfully stalled attempts to implement a national health-care system or similar state-funded programs, even as many European countries were moving in this direction. Suspicious of state-intervention in their practices, the AMA lobbied against the Sheppard-Towner Act of 1921, which provided federal funds for maternity clinics and infant care. Eight years later, the AMA blocked renewal of the program. Even as the economic crisis of the 1930s made non-intervention in public health inconceivable to most Americans, the AMA still struggled to come to terms with state intervention in health care. In 1950, the presidential oath adopted by the AMA included the promise that “I shall champion the cause of freedom in medical practice—and freedom for all my fellow Americans.” As Medicare and Medicaid became foundational to the American welfare state, the medical profession struggled to walk the tightrope of providing patient care while balancing acceptance of federal regulation against professional independence.
Since the 1960s, medical organizations, especially the American Medical Association, have sought to ensure that any political intervention into health care would ensure greater access to services and improve the health and well-being of American citizens. A timeline on the AMA’s website reveals a long list of issues over which physicians claimed authority and to which they demanded federal response in the form of research funding, policy mandates, and legislation: newborn screening, family planning initiatives, reducing air pollution, tobacco regulation, mandatory seat-belt laws, government-funded research for AIDS, and even expansion of public and private insurance systems in order to get more Americans access to affordable and quality health care.
What is incredible about the current situation, then, is not that the American Congress of Obstetricians and Gynecologists has protested politicians’ efforts to regulate women’s health care in this country, but that it has taken them so long to do so. A week before (the May 22 letter did not appear in print until June 5) Dr. Breen wrote his strongly-worded defense of women’s reproductive rights and health care to the editors of The New York Times, Drs. Marcia Angell and Michael Greene called on the AMA and the ACOG to comment on the legislative firestorm directed at women’s reproductive health in a May 15 column in USA Today, asking “Where are the Doctors?” The only response from the American Medical Association, thus far, has come in a May 28 letter to the editor of USA Today written by the chair of the AMA’s Board of Trustees, Robert M. Wah, who asserted, “Decisions about a patient’s medical care should be left to the patient and his or her physician without government intrusion.” Women and their specific reproductive health care needs, including the ability to control reproduction, were not mentioned at all.